Most Breast Imaging Centers Are Not Following National Screening Guidance

Whitney J. Palmer

Across the country, many breast imaging facilities are opting to provide screening mammography earlier and more often.

Most U.S. breast imaging centers are not in lock-step with current national screening mammography recommendations – instead, they are opting to provide screenings earlier and more often to women.

In a cross-sectional study published March 15 in JAMA Internal Medicine, investigators from Weill Cornell Medicine show that specialty society and government guidance on screening mammography is antiquated.

“Most U.S. breast centers recommend that women begin receiving screening mammography at an earlier age and more frequently than recommended by national societies,” said the team led by Jennifer L. Marti, M.D., from the division of breast and endocrine surgery.

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Judging by how imaging centers approach screening efforts today, they said, recommendations from the American Cancer Society and the U.S. Preventive Services Task Force fall more in line with long-standing practices from other countries. Their guidance is rooted in data that reflect the potential harms of earlier screening – false positives, unnecessary biopsies, patient anxiety and discomfort, over-diagnosis, and over-treatment.

But, based on the team’s findings, a significant portion of breast imaging centers are opting for another path. The team reviewed screening guideline recommendations based on starting age and screening interval from 606 breast imaging centers between December 2019 to July 2020 and determined that 487 (80.4 percent) did provide guidance to patients. Among the centers, 11 (9.2 percent) were National Cancer Institute (NCI)-designated, and 108 (90.8) were not.

Of the imaging centers providing recommendations, 431 (88.5 percent) suggested starting screening at a specific age – 376 (87.2 percent) recommended starting at age 40, a deviation from national society guidance, 35 (8.1 percent) recommended age 45, and 20 (4.6 percent) pointed to age 50. In addition, 429 imaging centers (88.1 percent) designed their recommendations around both age and screening interval, supporting annual screening at age 40.

The team did note some differences that were not statistically significant between National Cancer Institute (NCI)-designated facilities and non-NCI facilities. NCI facilities were less likely to recommend breast cancer screening begin at 40 – 37 NCI (69.8 percent) versus 339 (78.1 percent) of non-NCI imaging centers – but, they were more likely to suggest that women discuss the screening decision with their doctor – 9 centers (17 percent) versus 47 non-NCI centers (10.8 percent).

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Based on their analysis, they said, U.S. imaging centers likely prioritize patient and physician preferences, specialty society recommendations, litigation concerns, and financial considerations when designing their screening recommendations. While decision aids and results from ongoing clinical trials, such as the Women Informed to Screen Depending on Measure of Risk (WISDOM) study, can help women make their choices on screening mammography, what they hear from their imaging center is impactful, the team said.

“Recommendations by breast centers are influential, as physicians and the public look to specialists for guidance on this complex issue,” they said. “Breast center recommendations may also reflect broader practice factors in the [United States.]”

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