Physician Breast Cancer Screening Recommendations Following Guideline Changes

Radhakrishnan, Archana; Nowak, Sarah A.; Parker, Andrew M.; Visvanathan, Kala; Pollack, Craig Evan

doi:10.1001/jamainternmed.2017.0453

Cited by 48 publications

(47 citation statements)

References 5 publications

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“…We found that participants reiterated their beliefs and feelings of commitment to undergoing breast cancer screening, which may be in conflict with current guidelines. Thus, physicians may benefit from strategies that provide a way to discuss guidelines with patients as a way to implement current clinical guidelines into practice . This may be addressed by engaging women in a tailored strategy that incorporates their personal values and beliefs as they assess the benefits and downsides of continuing breast cancer screening as they age .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, physicians may benefit from strategies that provide a way to discuss guidelines with patients as a way to implement current clinical guidelines into practice. 31,32 This may be addressed by engaging women in a tailored strategy that incorporates their personal values and beliefs as they assess the benefits and downsides of continuing breast cancer screening as they age. 18 Using a shared decision making strategy can allow women to discuss their values and to weigh the complex tradeoffs between different, viable options.…”

Section: Discussionmentioning

confidence: 99%

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Resistance to discontinuing breast cancer screening in older women: A qualitative study

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Resistance to discontinuing breast cancer screening in older women: A qualitative study

et al. 2018

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“…Further, population estimates were for women aged 45‐74, the age category available in ACS that is most congruent with recommended screening ages. However, many women who utilize screening are younger or older than the recommended screening age . Thus, the population estimates used are representative of theoretical demand, not practical demand.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

“…However, many women who utilize screening are younger or older than the recommended screening age. 37 Thus, the population estimates used are representative of theoretical demand, not practical demand.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Spatial Accessibility to Mammography Services in the Lower Mississippi Delta Region States

Zahnd

McLafferty

Sherman

et al. 2019

The Journal of Rural Health

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Purpose To characterize spatial access to mammography services across 8 Lower Mississippi Delta Region (LMDR) states. These states include the Delta Region, a federally designated, largely rural, and impoverished region with a high proportion of black residents and low mammography utilization rates. Methods Using the enhanced 2‐step floating catchment area method, we calculated spatial accessibility scores for mammography services across LMDR census tracts. We compared accessibility scores between the Delta and non‐Delta Regions of the LMDR. We also performed hotspot analysis and constructed spatial lag models to detect clusters of low spatial access and to identify sociodemographic factors associated with access, respectively. We obtained mammography facility locations data from the Food and Drug Administration and sociodemographic variables from the American Community Survey and the US Department of Agriculture. Results Overall, there were no differences in spatial accessibility scores between the Delta and non‐Delta Regions, though there was some state‐to‐state variation. Clusters of low spatial access were found in parts of the Arkansas, Mississippi, and Tennessee Delta. Spatial lag models found that poverty was associated with greater spatial access to mammography. Conclusions The lack of identified differences in spatial access to mammography in the Delta and non‐Delta Regions suggests that psychosocial or financial barriers play a larger role in lower mammography utilization rates. Identifying clusters of low spatial access to mammography services can help inform resource allocation. Further, our study underscores the value of using coverage‐based methods rather than travel time or container measures to evaluate spatial access to care.

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“…These practical challenges may make it easier to simply order routine screening mammograms for women in their 40s, as many primary care physicians do. 1 Expanded use of decision tools, which could be used by patients at home or in office waiting rooms, could help to improve the quality of the information shared with patients and make shared decision making more efficient and feasible. Research demonstrates that such tools can increase knowledge and decrease decisional conflict and anxiety; in some cases, they also influence uptake of screening.…”

Section: Supplemental Contentmentioning

confidence: 99%

Breast Cancer Screening in 2018

Keating

Pace

2018

JAMA

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In the past 9 years, there has been a major shift in the recommendations for breast cancer screening. Recognizing additional evidence about the harms of mammography, in 2009, the United States Preventive Services Task Force (USPSTF) revised its previous recommendation of annualmammogramsforallwomen beginning at age 40 years and instead recommended biennial mammograms for women aged 50 to 74 years. The USPSTF recommended against routine screening mammography for women aged 40 to 49 years, stating that the decision to start regular mammography before age 50 years should be an individual one that considers how each patient values specific benefits and harms. The USPSTF reiterated this recommendation in a 2016 update, and other organizations, notably the American Cancer Society in 2015, have joined the USPSTF in recommending less routine use of mammography and a more individualized approach to screening. Nevertheless, research has documented little change in US screening practices. Among primary care physicians surveyed in 2016, recommendations for screening were high across all patient age groups, with more than 80% of 871 surveyed physicians reporting they would recommend screening to women aged 40 to 44 years, for whom major guidelines recommend against routine screening. 1 Evidence from the National Health Interview Survey, which assessed patients' reports of their most recent mammogram in 2008, 2010, 2013, and 2015, shows minimal changes in rates of mammography screening over time. 2 Recent articles 3,4 have highlighted some hypotheses about why mammography practices have not changed despite revisions to guidelines. Grady and Redberg 3 proposed that general enthusiasm for testing in the United States, generations of emphasis only on benefits of screening, concerns about litigation, and the US fee-forservice payment system are key factors. Kopans et al 4 suggested that physicians disagree with the guidelines and reject the idea that the harms of screening mammography for younger women outweigh the benefits. It is also likely that clinicians and patients overestimate the benefit of mammograms in preventing breast cancer deaths. However, the most important contributor to limited uptake of these guidelines may be the challenge clinicians have in truly engaging patients in shared decision making to individualize screening decisions. Despite uncertainty about the extent to which evidence from randomized clinical trials conducted decades ago generalizes to current mammography practice, most experts agree that screening mammography lowers the risk of death from breast cancer. A metaanalysis of 8 randomized clinical trials involving more than 600 000 women suggested that mammography was associated with a 19% relative risk reduction in breast cancer mortality, a reduction that differs by age, ranging from an approximately 8% relative risk reduc

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Physician Breast Cancer Screening Recommendations Following Guideline Changes

Cited by 48 publications

References 5 publications

Resistance to discontinuing breast cancer screening in older women: A qualitative study

Resistance to discontinuing breast cancer screening in older women: A qualitative study

Spatial Accessibility to Mammography Services in the Lower Mississippi Delta Region States

Breast Cancer Screening in 2018

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