Screening Mammography for Young Women in Israel: Between Guidelines and Common Practice.

Abstract

Background. Breast cancer screening via mammography for women younger than 50 y sparks controversy due to balancing benefits and risks. In Israel, specific criteria govern early screening initiation, yet global studies reveal low adherence to guidelines for this demographic. Objectives. This study aims to report on young women's referrals for screening mammography in Israel, assess adherence to guidelines, and identify factors influencing guideline adherence. Design, Setting, and Participants. A cross-sectional study analyzed referral letters for screening mammography issued to women aged 18 to 49 y from March 2019 to February 2020 in 2 districts of Israel's largest health care provider. Exclusions included women with a history of breast cancer or BRCA mutations. Of 9,960 letters, 1,287 were randomly selected for adherence assessment, with 13% of nonadherent cases further reviewed. Main Outcomes and Measures. Primary outcomes included categorizing referrals as adherent or nonadherent to guidelines. Additional measures explored correlations between adherence and patient characteristics (e.g., age, comorbidities) and the referring physician's specialty. Results. A total of 999 referral letters were included in the statistical analysis. Referrals spanned all ages but skewed toward women older than 40 y. Of the referrals, 45% (452) came from general surgeons and 32% (327) from family physicians. Twenty-four percent (303) of referrals were blank, and 1% (4) involved risk-benefit discussions. In total, 109 (10.9%) of the referrals strictly adhered to guidelines; under a lenient approach, 30.6% (307) adhered. General surgeons adhered more frequently than gynecologists did (32.8% [109] v. 14.9% [11], P = 0.014). Conclusions and Relevance. Despite official guidelines, many physicians in Israel did not follow recommendations for breast cancer screening in women younger than 50 y, highlighting a gap between evidence-based medicine and clinical practice.

Highlights: Question Are screening mammography referrals, given to women younger than 50 y of age, adherent to current guidelines? Findings In this cross-sectional study of a randomly selected sample of 1,287 referral letters, given to women aged 18 to 50 y, only 10.9% were adherent with the guidelines when examined with a strict approach and 30.6% with a forgiving approach. Adherence significantly correlated with the field of the referring physician. Meaning Despite known risks of screening mammography, women younger than 50 y are commonly referred to such screening in a deviation from current guidelines.