The Reading Room

Your surgeons ignore the USPSTF breast screening recommendations, but do your patients?

by Solomon Banjo

The United States Preventive Services Task Force (USPSTF) recently released a draft recommendation reaffirming its 2009 position that women 50-74 years of age should receive biennial screening mammograms instead of annual screenings starting at 40.

Despite the opposition from the American Cancer Society, the American College of Radiology (ACR), and other stakeholders, the USPSTSF recommendations are having a tangible impact on patient decisions. Two recent studies show how the conflict between the USPSTF and many in the medical community relates to patient’s decisions to receive screening mammograms.

The majority of surgeons ignore the USPSTF recommendations

Researchers from the Banner MD Anderson Cancer Center, the VA San Diego Health Healthcare System, University of California San Diego School of Medicine, and New York University School of Medicine looked at the impact the USPSTF’s 2009 recommendations had on surgeons’ mammography recommendations. They found that 88% of breast surgeons and 82% of general surgeons continue to recommend annual mammograms for women over 40 with an average risk of developing breast cancer. Additionally, 93% of these surgeons reported that they either began, or would begin, annual screenings for themselves at age 40.

This study did not assess the attitudes of primary care physicians (PCPs), so it is not clear to what degree, if any, the opinions of PCPs differ from surgeons. However, contrary to what we might expect it seems as though many patients are indeed following the USPSTF recommendations and are receiving fewer mammograms.

The 2009 recommendations have led to a decrease in mammography screening rates

A study published in Women’s Health Issues found that mammography screening rates for Medicare patients aged 65-90 decreased significantly following the 2009 recommendations. The researchers found that overall the mammography screening rate decreased by 6% after one year and 8% after three years compared to what would have been expected based on historic growth patterns. This decline is something we have noticed in our volumes survey data pictured below.

mammography

Looking at data above from our annual volumes surveys we see that mammography volumes have been rocky since the 2009 recommendation despite increased insurance coverage under the Affordable Care Act (ACA). Cost should not be a barrier to receiving mammograms as CMS continues to reimburse for annual exams and the ACA covers annual screenings for women over 40 without cost sharing, meaning these exams are free for patients. These factors demonstrate that despite the strong feelings many physicians have on the topic of breast screening, their message is not getting through to patients. This disconnect highlights a need for providers to better engage patients to ensure that they receive appropriate care.

Providers must engage patients more effectively

The USPSTF recommendation and media coverage regarding breast cancer are primary factors driving patients to forego annual mammograms. In response to this trend, providers must engage patients more effectively in conversations regarding breast cancer screening in order to ensure they understand the risks and benefits and enable them to make the best decision for themselves. There are now 22 states with breast density notification laws, but this policy only works if providers truly engage with their patients.

Many providers are realizing the increasing complexity surrounding breast screening decisions and are equipping their physicians accordingly. The UNC School of Medicine developed a shared decision making aide in the wake of their state’s breast density law to help clinicians engage patients in these conversations. Breast and lung cancer screening are one way radiology can help improve the current level of informed patient decision making and ensure that the appropriate patients receive these lifesaving examinations.

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