Perhaps rules are meant to be broken. But guidelines, according to recent research, are not always followed when physicians recommend breast cancer screening to patients.

A research letter published Dec. 4 in JAMA: Internal Medicine, explores how social interactions with friends, family and colleagues who have been diagnosed with breast cancer may affect a physician’s recommendations to patients.

Led by Craig Evan Pollack, MD, MHS, with Johns Hopkins University in Baltimore, a group of researchers surveyed 848 physicians who had a social network member diagnosed with breast cancer. Some 44.7 percent were general practitioners or specialized in family medicine, with 29 percent in internal medicine and 26.3 in gynecology. These physicians reported 1,631 social network members receiving breast cancer diagnoses, including 771 patients and 381 family members.

Physicians familiar with someone with a poor prognosis who was not diagnosed via screening were much more likely to recommend routine checks for women between 40 and 44 years old and those over 75.

“Describing a woman whose breast cancer was not diagnosed by screening mammogram and who had a poor prognosis was associated with increased odds of recommending routine screening to patients within the designated younger and older age groups for which guidelines no longer support routine, universal screening,” Pollack et al. wrote. “Our results suggest that helping clinicians reflect on how their experiences influence their current screening patterns may be an important approach to improve adherence to revised breast cancer screening guidelines.”

The researchers noted how bad experiences are recalled more frequently than positive ones, which can lead physicians to perceive a greater risk than those not familiar with dreaded outcomes.