Physician Relationships May Sway Breast Cancer Screening Recommendations

Conflicting breast cancer treatment guidelines can leave many decisions to the discretion of the provider.

A recent study published by JAMA Internal Medicine suggests that prior physician relationships with women who have experienced breast cancer may affect future recommendations for mammograms.

The authors found that physicians who knew at least 1 patient, family member, or friend who received a poor disease prognosis and who did not undergo breast cancer screening were more likely to recommend younger and older patients to receive a mammogram. Typically, these populations are not recommended to receive this type of cancer screening, but guidelines are conflicting.

These findings underscore the effect that physicians’ previous relationships may have on breast cancer screening guidelines.

“Our findings suggest that we need to help clinicians better understand the impact personal experiences with friends and family members, as well as their patients, have on their practices,” said lead author Craig Evan Pollack, MD, MHS.

Currently, the American Cancer Society recommends that women aged 40 to 44 years should make personalized decisions, start annual screenings at age 45, and receive biennial screenings at 55 years and older. However, the US Preventive Task Force recommends women aged 40 to 49 years should make personalized decisions and start biennial mammograms at age 50 and stop at age 74.

In the new study, the authors examined survey data taken by 848 primary care providers in the United States.

The surveys asked physicians to discuss the experiences of a patient and a friend or family member who was diagnosed with breast cancer and the diagnosis that had the strongest impact. According to the authors, physicians were asked to categorize the breast cancer experience as: diagnosed through screening and with a good prognosis; not diagnosed through screening and with a good prognosis; diagnosed through screening and with a poor prognosis; not diagnosed through screening and with a poor prognosis; or unknown screening or prognosis.

Physicians were also asked whether they recommend routine mammograms to average-risk patients with no history of breast cancer aged 40 to 44 years, 45 to 49 years, and 75 years and older.

There were 848 physicians—a majority of whom were males—who responded about 1631 women they knew who had been diagnosed with breast cancer, including 771 patients, 381 family members, and 474 other individuals in their social network.

Of the 848 physicians, 246 practiced internal medicine, 379 practiced family medicine, and 223 practiced gynecology.

The authors found that 92.7% of physicians who knew at least 1 woman in their social network with a poor breast cancer prognosis who did not receive a screening recommended a mammogram to patients aged 40 to 44 years compared with 85.6% of other physicians, according to the study.

Physicians with a relationship to a woman with breast cancer were also more likely to recommend the screening to women aged 75 years and older compared with other physicians (84% versus 68.3%, respectively), according to the study.

These findings highlight how physicians’ personal relationships and experiences with other patients may sway their decisions about breast cancer screening where guidelines are blurred.

“As a first step toward increasing adherence to guidelines, it may be necessary to create opportunities and messaging strategies that help physicians recognize the experiences that help shape their recommendations,” Dr Pollack said.