'Practice what you preach': Radiologists follow same breast cancer screening recommendations they give to patients

Nearly 98 percent of radiologists recommend annual breast cancer screening for women aged 40 and above while adhering to the same recommendations for their own preventative care, according to results of a study published in the June issue of the American Journal of Roentgenology.

The U.S. Preventative Services Task Force (USPSTF) recommends breast cancer screening for women 50–74 years old on a biennial basis only and cautions against routine mammography for women aged 40–49 years old, stating that the decision to participate in preventative breast cancer screening should “be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.”

Many professional radiology associations and women’s health advocacy groups disagree with these guidelines, asserting that screening must begin early and occur annually. But according to Jiyon Lee, MD, of the New York University School of Medicine, and her colleagues, there is one group of people uniquely qualified to offer opinions as to when and how breast cancer screening should be implemented. “A variable overlooked in this discussion is the opinions of the physicians, especially breast imaging radiologists,” wrote Lee et al, “who are entrusted with understanding the issues at stake and translating that knowledge into supportable evidence-based recommendations for others."

Lee and her team set out to investigate the consistency of radiologists’ recommendations regarding breast cancer screening and evaluate whether their own mammography frequencies matched those they recommend to patients. To do so, they reviewed survey responses from 487 breast radiologists across the country to assess mammography recommendations to patients as well as their personal screening habits. The respondents were separated into three cohorts—women aged 40 and above (group 1), women younger than 40 years (group 2) and men (group 3)—and responses for each cohort were computed and summarized.

The results revealed that none of the radiologists agreed with the USPSTF recommendations of biennial mammography for patients ages 50–74 years, while 98 percent (477/487) believe yearly mammography beginning at age 40 to be the best strategy for breast cancer screening. In group 1, 96 percent (191/198) undergo annual screenings, while 100 percent (83/83) of respondents in group 2 said they have or will have annual mammography beginning at age 40. In group 3, 97 percent (171/176) would follow the same recommendations if they were women. The overall rate of radiologists who would follow a plan of annual breast cancer screening beginning at age 40 was 97 percent (445/457).

“Nearly all of the radiologists recommend yearly mammography for average-risk women 40 years old and older and were consistent in that they ‘practice what they preach,’” the authors concluded. “Because radiologists diagnose all stages of breast cancer, their personal convictions should influence providers, patients, and the public when considering the [USPSTF] screening guidelines.”