Breast and general surgeons still advocate annual screenings for average-risk patients

The vast majority of surgeons continue to recommend that women 40 years old or older with an average risk for breast cancer be screened annually for the disease, despite a 2009 U.S. Preventive Services Task Force (USPSTF) recommendation that such women be screened biennially beginning at 50 years old and continuing through age 74.

A team of researchers studying the efficacy of policy recommendations on practicing surgeons found that 88% of breast surgeons and 82% of general surgeons continue to recommend annual mammography for women with an average risk of developing breast cancer. An even greater percentage - 93% - reported that they began or would begin annual screenings for themselves at age 40.

"We found that the majority of surveyed breast surgeons advocate and personally follow the screening mammography recommendations of the American Cancer Society, the American College of Radiology, and the Society of Breast Imaging, instead of those of the USPSTF," said coauthor Vilert Loving, director of breast imaging at the Banner MD Anderson Cancer Center. Coauthors Jiyon Lee (NYU Cancer Institute) and Elaine Tanaka (VA San Diego Healthcare System and UC San Diego School of Medicine) added, "As we anticipate the USPSTF's impending guidelines this year, the public should know that the physicians who diagnose and treat women with breast cancer still believe in annual mammography starting at age 40 for average-risk women."

The study was presented at the ARRS 2015 Annual Meeting in Toronto.


5206. Mammography Recommendations and Personal Screening Habits of Breast Surgeons in the United States Amid the Screening Mammography Controversy Since the 2009 USPSTF Guidelines

Loving V1*, Tanaka E2,3, Lee J4 1. Banner MD Anderson Cancer Center, Gilbert, AZ; 2. VA San Diego Healthcare System, San Diego, CA; 3. University of California San Diego School of Medicine, San Diego, CA; 4. New York University School of Medicine, New York, NY

Objective: Breast cancer screening recommendations vary among healthcare providers and may be influenced by external factors such as the 2009 U.S. Preventive Services Task Force (USPSTF) guidelines. We aimed to determine the screening recommendations that breast surgeons advocate to their average-risk patients, friends, and family and follow for themselves.

Materials and Methods: Breast surgeons participated in an institutional review board-exempt, anonymous Internet-based survey from June 16, 2014, through August 11, 2014. Collected data included the surgeons' personal and practice backgrounds, their screening mammography, clinical breast examination, and breast self-examination recommendations for patients and family/friends, and their personal screening habits. The surgeons were divided into three cohorts: women = 40 years old (group 1), women < 40 years old (group 2), and men (group 3). Personal screening questions for group 3 were structured for the surgeon to answer as if he were female. Responses were tallied and distributions calculated.

Results: In all, 288 surveys were collected. Fifty-three percent (153/288) of respondents characterized themselves as breast surgeons and 47% (135/288) as general surgeons who perform breast surgery. Eighty-five percent (197/232) and 86% (200/232) of overall respondents recommend annual screening mammograms starting at age 40 years for patients and family/friends, respectively. This recommendation was advocated by 88% (107/122) of breast surgeons and 82% (90/110) of general surgeons. The 2009 USPSTF guideline of biennial screening mammography between ages 50 and 74 years was advocated by 6% (14/232) and 7% (17/232) of surgeons for their patients and family and friends, respectively. Regarding personal screening habits, 88% (80/91) of group 1 currently do and 97% (29/30) of group 2 do or will undergo annual mammography. In group 3, 94% (98/104) would undergo annual mammography. Common reasons for not undergoing annual mammography include the belief that biennial screening is equally efficacious and that the lack of high-risk status obviates annual screening. In group 1, 19% (18/94) will stop screening mammography at age 75-80 years. The 2009 USPSTF recommendations impacted 22% (50/226) of respondents' screening mammography recommendations for others and 14% (31/227) of respondents' personal screening behavior. However, the degree of impact varied from simply opening discussions with patients regarding the utility of screening to switching from annual to biennial screening and initiating tailored risk-based screening.

Conclusion: The majority of surgeons (88% breast surgeons, 82% general surgeons) recommend annual screening mammography starting at 40 years old for average-risk patients, family, and friends. A higher percentage of surgeons (93% average; 88%, 97%, and 94% of the respective cohorts) report that they do or would undergo annual screening starting at 40 years of age, indicating their level of personal conviction in annual screening mammography. The 2009 USPSTF screening mammography guidelines had a low impact on the surgeons' recommendations to others and themselves. This study has implications regarding the effect of policy recommendations on practicing surgeons.