Screening Mammography: Guidelines versus Clinical Practice

Abstract Objective To understand physicians’ comprehension of breast cancer screening guidelines and the existing literature on breast cancer screening, and whether this contributes to how patient screening is implemented in clinical practice. Methods A survey of 18 questions was distributed across the United States via e-mail and social media resources to physicians and medical students of all disciplines and levels of training. Responses from 728 physicians and medical students were reviewed. Respondents were from over 200 different institutions and over 60 different medical specialties. Results Our survey demonstrates that more than half of the participants felt uncomfortable in their knowledge of breast cancer screening recommendations (399/728, 54.8%) and existing literature on breast cancer screening (555/728, 76.2%). When stratified based on level of training, those at the attending level reported a greater level of comfort in their knowledge of breast cancer screening recommendations (168/238, 70.6%) and literature (95/238, 39.9%) compared with respondents at the trainee level. Attending physicians are also more likely to recommend screening for patients between the ages of 40–49 years old (209/238, 87.7%) compared to those at the trainee level. Responses on whether to screen based on age were most consistent for patients ages 50–74, with greater than 90% of the respondents endorsing screening mammogram for this age group in all levels of training. There were greater inconsistencies in the support to screen age groups 40–49 and 75+ . Conclusions The results showed a disparity in screening practices by clinicians in all levels of training, particularly for patients ages 40–49 and 75+ , and for the interval of screening. Later initiation with less frequent intervals between screens may reduce the impact of screening on mortality reduction.

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Impact of the U.S. Preventive Services Task Force update for breast cancer screening on mammography utilization in women age 40 to 49.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.5 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 5-5

Author(s):

Amy T. Wang ◽

Jiaquan Fan ◽

Holly K. Van Houten ◽

Nilay D. Shah

Keyword(s):

Breast Cancer ◽

Time Series ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Task Force ◽

Screening Mammography ◽

Administrative Claims ◽

Post Intervention ◽

Start Date ◽

The Impact

5 Background: The 11/2009 USPSTF breast cancer screening update recommended against routine screening mammography for women age 40-49, created confusion and prompted organizations to release opposing statements. We aimed to determine if the USPSTF update for breast cancer screening impacted screening mammography utilization in women age 40-49. Methods: We conducted a time-series analysis utilizing administrative claims data from over 100 health plans. Women ages 40-64 with at least one month of enrollment from 01/2006-12/2010 were included. Medicare claims are not included and thus women ≥65 were excluded. The start date of 01/2006 was chosen to account for possible effects of the recent recession. We developed claims-based algorithms to identify the number of monthly screening mammograms. Time series models were fit using SAS PROC AUTOREG; strong seasonal fluctuations were adjusted by including an autoregressive error of order 12. Results: Over 7.9 million women were included. Prior to the intervention, the baseline monthly mammography rate was 40.9/1,000 women for the 40-49 group and 47.4/1,000 women for the 50-64 group. Based on projections from pre-intervention trends, the update was associated with a 5.72% (1.27,10.18) and 4.97% (1.11,8.84) decrease in mammography rate at 3 and 10 months post-intervention, respectively in the 40-49 group. The intervention had no effect on mammography rates in the 50-64 group. This translates to 53,969 fewer mammograms performed in the year following the update for women ages 40-49 in this dataset. Conclusions: We present the first estimates of the impact of the USPSTF breast cancer screening update using a large nationally representative database. The update was associated with a small but significant decrease in mammography rates for women ages 40-49, while no change was seen for women ages 50-64, which is consistent with the context of the guideline change. A modest effect is also in line with public backlash and the release of numerous conflicting guidelines. These findings underscore the need for further research on benefits and risks of screening mammography as it is difficult to act on numerous sources of contradictory information.

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Breast cancer screening patterns in Jamaican women: review of the largest national mammography clinic

BMC Women s Health ◽

10.1186/s12905-021-01295-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sheray N. Chin ◽

Derria Cornwall ◽

Derek I. Mitchell ◽

Michael E. McFarlane ◽

Joseph M. Plummer

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Cancer Diagnosis ◽

Mammographic Screening ◽

Screening Mammography ◽

Screening Guidelines ◽

National Breast ◽

Jamaican Women ◽

The Impact

Abstract Background Breast cancer is the leading cause of cancer and cancer related deaths in Jamaican women. In Jamaica, women often present with advanced stages of breast cancer, despite the availability of screening mammography for early detection. The utilization of screening mammography for early breast cancer diagnosis seems to be limited, and this study investigated the national patterns of mammographic screening and the impact of mammography on the diagnosis of breast cancer in Jamaica. Methods A retrospective analysis of the records of the largest mammography clinic in Jamaica was done for the period January 2011 to December 2016. Descriptive statistics was performed on relevant patient characteristics with calculation of rates and proportions; cross-tabulations were utilized to assess relationship of covariates being studied on the outcomes of interest. Results are reported in aggregate form with no identifiable patient data. Results 48,203 mammograms were performed during the study period. 574 women (1.2%) had mammograms suspicious for breast cancer with median age of 57 years (range 30–95 years); 35% were under the age of 50. 4 women with suspicious findings had undergone ‘screening mammography’, with the remaining having ‘diagnostic mammography’. 38% reported previous mammograms, with a mean interval of 8 years between previous normal mammogram and mammogram suspicious for breast cancer. Median age at first screening mammogram was 51 years (range 41–77). Conclusion Breast cancer screening mammography is underutilized in Jamaica. An organized national breast cancer screening programme is recommended to improve adherence to international breast cancer screening guidelines.

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Breast Cancer Screening and the COVID-19 Pandemic

Journal of Breast Imaging ◽

10.1093/jbi/wbaa106 ◽

2020 ◽

Author(s):

Dana H Smetherman

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Clinical Care ◽

The United States ◽

Screening Mammography ◽

Imaging Studies ◽

National Organizations ◽

Screening Mammograms

Abstract The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Initially, nonessential imaging studies, including screening mammography, were curtailed and even temporarily halted when lockdowns were instituted in many parts of the United States. As a result, imaging volumes plummeted while health care institutions worked to ensure safety measures were in place to protect patients and personnel. As COVID-19 infection levels started to stabilize in some areas, breast radiology practices sought guidance from national organizations, such as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and radiology specialty societies, to develop strategies for patients to safely return for screening mammograms and other outpatient imaging studies. Postponement of breast cancer screening has led to delays in cancer diagnosis and treatment that could negatively affect patient outcomes for years to come. In order to continue to provide necessary imaging services, breast radiologists will need to face and overcome ongoing practical challenges related to the pandemic, such as negative financial impacts on practices and patients, the need for modifications in delivery of imaging services and trainee education, and differences in the health care system as a whole, including the shift to telehealth for clinical care. Nonetheless, despite the disruption the COVID-19 pandemic has caused, the need for breast radiology procedures, including breast cancer screening, remains strong.

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Disability as a predictor of breast cancer screening uptake: A population-based study of 57,328 women

Journal of Medical Screening ◽

10.1177/0969141319888553 ◽

2019 ◽

Vol 27 (4) ◽

pp. 194-200

Author(s):

Emma Ross ◽

Aideen Maguire ◽

Michael Donnelly ◽

Adrian Mairs ◽

Clare Hall ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Northern Ireland ◽

Breast Cancer Screening ◽

Breast Screening ◽

The United States ◽

Ageing Population ◽

Screening Uptake ◽

National Breast ◽

The Impact

Objective Despite a growing body of evidence suggesting inequalities in breast cancer screening uptake in the United States for women with disabilities, few attempts have been made to examine whether this association applies to the United Kingdom. We conducted the first population-wide study investigating the impact of disability on uptake of breast cancer screening in Northern Ireland. Methods Breast screening records extracted from the National Breast Screening System were linked to the Northern Ireland Longitudinal Study. This identified a cohort of 57,328 women who were followed through one complete three-year screening cycle of the National Health Service Breast Screening Programme in Northern Ireland. The presence of disability was identified from responses to the 2011 Census. Results Within this cohort, 35.8% of women reported having at least one chronic disability, and these individuals were 7% less likely to attend compared with those with no disability (odds ratio 0.93; 95% confidence interval 0.89–0.98). Variation in the degree of disparity observed was evident according to the type and number of comorbid disabilities examined. Conclusion This is the first population-wide study in Northern Ireland to identify disparities in breast screening uptake for women with chronic disabilities, in particular, those with multimorbidity. This is of particular concern, given the projected rise in the prevalence of disability associated with the ageing population.

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Issues in Breast Cancer Screening

Technology in Cancer Research & Treatment ◽

10.1177/153303460500400102 ◽

2005 ◽

Vol 4 (1) ◽

pp. 5-9 ◽

Cited By ~ 2

Author(s):

Etta Pisano

Keyword(s):

Breast Cancer ◽

United States ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cancer Mortality ◽

Breast Cancer Mortality ◽

The United States ◽

Screening Mammography ◽

High Threshold ◽

Breast Cancer Imaging

This paper will review the use of screening mammography in the United States, with an emphasis on its limitations as currently practiced. It will then emphasize several areas where breast cancer imaging practice can be improved, namely in reducing overtreatment of potentially nonlethal cancers, in monitoring the effectiveness of nonsurgical therapies, and in guiding noninvasive therapies. Any new modality that is to have an impact on breast cancer mortality must perform comparably to screening mammography to become widely utilized. While mammography is not perfect, it has set a high threshold that other modalities must reach before they will be widely utilized for screening or diagnosis.

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The Impact of Race, and Insurance Status on Breast Cancer Screening: Results from the Behavioral Risk Factor Surveillance System Data

10.21203/rs.3.rs-427806/v1 ◽

2021 ◽

Author(s):

Salamata Yoda ◽

Jennifer Mallow ◽

Laurie A. Theeke

Keyword(s):

Breast Cancer ◽

Health Insurance ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Multinomial Logistic Regression ◽

The United States ◽

Minority Women ◽

Insurance Status ◽

The Past ◽

The Impact

Abstract Purpose Breast cancer is the second major cause of cancer-related death of women in the United States 1, yet current gaps exist in breast cancer screening for minority women 2. The purpose of this study is to address these gaps by assessing the relationships among race, health insurance coverage, and breast cancer screening in a nationally representative sample of women. Design: A cross-sectional descriptive analysis of the 2018 BRFSS survey data was used to meet the study purpose. BRFSS participants who declared themselves to be of female sex and who were adults with the age ≥ of 40 years were selected for inclusion. Methods Data were analyzed using SPSS version 26. Exploratory and descriptive analyses were performed, followed by comparative analyses based on the variable type. Relationships between race, insurance status, and mammogram screening were examined. Chi-square, logistic, and multinomial logistic regression were used. Findings: The original 2018 BRFSS dataset included 437,436 participants and 145,837 women were selected based on inclusion criteria. Participant age ranged from 40 to 74 years. The majority were White only non-Hispanic (78.1%), reported having a mammogram in the past two years (76.1%), had earned < a 4-year college degree (61.1%), had an annual income of < $75,000 (58.4%) and married (58.2%). Less than half had a healthcare plan through an employer (44.9%) and were employed (40.5%). Participants who had a plan purchased through an employer or union were more likely to have a mammogram in the past two years when compared with other health coverage. Furthermore, White only, non-Hispanics were 1.25 times more likely and Black only, non-Hispanics were 1.98 times more likely to have a mammogram in the past two years compared to participants from other racial and ethnic groups. Conclusion The findings of this study provide an additional indication that race, and health insurance status do impact breast cancer screening. Clinical Relevance: Knowledge gained from this study can be used by practicing nurses to educate racial and ethnic minority women on the significance of breast cancer screening and prevention.

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Breast Cancer screening patterns in Jamaican women: review of the largest national mammography clinic

10.21203/rs.2.24515/v1 ◽

2020 ◽

Author(s):

Sheray N Chin ◽

Derria Cornwall ◽

Derek Mitchell ◽

Michael McFarlane ◽

Joseph Plummer

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Cancer Diagnosis ◽

Screening Mammography ◽

Screening Guidelines ◽

National Breast ◽

Abnormal Mammogram ◽

Jamaican Women ◽

The Impact

Abstract Background Breast cancer is the leading cause of cancer and cancer related deaths in Jamaican women. In Jamaica, women often present with advanced stages of breast cancer, despite the availability of screening mammography for early detection. The utilization of screening mammography for early breast cancer diagnosis seems to be limited, and this study investigated the national patterns of mammographic screening and the impact of mammography on the diagnosis of breast cancer in Jamaica.Methods A retrospective analysis of the records of the largest mammography clinic in Jamaica was done for the period January 2011 to December 2016. Descriptive statistics was performed on relevant patient characteristics with calculation of rates and proportions; cross-tabulations were utilized to assess relationship of covariates being studied on the outcomes of interest. Results are reported in aggregate form with no identifiable patient data.Results 48,203 mammograms were performed during the study period. 574 women (1.2%) had mammograms suspicious for breast cancer with median age of 57 years (range 30 – 95 years); 35% were under the age of 50. 4 women with suspicious findings had undergone ‘routine mammography’, with the remaining having ‘diagnostic mammography’. 38% reported previous mammograms, with a mean interval of 8 years between previous normal mammogram and abnormal mammogram. Median age at first screening mammogram was 51 years (range 41-77).Conclusion Breast cancer screening mammography is underutilized in Jamaica. An organized national breast cancer screening programme is recommended to improve adherence to international breast cancer screening guidelines.

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