Neta Essar Schvartz, Michal Rotem-Green, Dikla Kruger, Anat Gaver, Inbar Safra, Danielle Mira Harari, Nadav Niego, Mordechai Alperin
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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. <b>Main Outcomes and Measures.</b> 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. <b>Results.</b> 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], <i>P</i> = 0.014). <b>Conclusions and Relevance.</b> 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.</p><p><strong>Highlights: </strong><b>Question</b> Are screening mammography referrals, given to women younger than 50 y of age, adherent to current guidelines? <b>Findings</b> 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. <b>Meaning</b> Despite known risks of screening mammography, women younger than 50 y are commonly referred to such screening in a deviation from current guidelines.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"10 1","pages":"23814683251317524"},"PeriodicalIF":1.7000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905013/pdf/","citationCount":"0","resultStr":"{\"title\":\"Screening Mammography for Young Women in Israel: Between Guidelines and Common Practice.\",\"authors\":\"Neta Essar Schvartz, Michal Rotem-Green, Dikla Kruger, Anat Gaver, Inbar Safra, Danielle Mira Harari, Nadav Niego, Mordechai Alperin\",\"doi\":\"10.1177/23814683251317524\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background.</b> 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. <b>Objectives.</b> 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. <b>Design, Setting, and Participants.</b> 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. <b>Main Outcomes and Measures.</b> 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. <b>Results.</b> 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], <i>P</i> = 0.014). <b>Conclusions and Relevance.</b> 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.</p><p><strong>Highlights: </strong><b>Question</b> Are screening mammography referrals, given to women younger than 50 y of age, adherent to current guidelines? <b>Findings</b> 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. <b>Meaning</b> Despite known risks of screening mammography, women younger than 50 y are commonly referred to such screening in a deviation from current guidelines.</p>\",\"PeriodicalId\":36567,\"journal\":{\"name\":\"MDM Policy and Practice\",\"volume\":\"10 1\",\"pages\":\"23814683251317524\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-03-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905013/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"MDM Policy and Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/23814683251317524\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"MDM Policy and Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/23814683251317524","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
背景。对50岁以下的女性进行乳房x光检查,因利弊权衡而引发争议。在以色列,早期筛查有具体的标准,但全球研究表明,这一人群对指南的遵守程度很低。目标。本研究旨在报道以色列的年轻女性转介乳腺x光筛查,评估对指南的依从性,并确定影响指南依从性的因素。设计,设置和参与者。一项横断面研究分析了2019年3月至2020年2月在以色列最大的医疗保健提供者的两个地区向18至49岁女性发放的乳房x光筛查转诊信。排除包括有乳腺癌病史或BRCA突变的女性。在9960封信函中,随机选择1287封进行依从性评估,并对13%的非依从性病例进行进一步审查。主要成果和措施。主要结果包括将转诊患者分类为遵循或不遵循指南。其他措施探讨依从性与患者特征(如年龄、合并症)和转诊医生专业之间的相关性。结果。统计分析共包括999封转介信。转诊涵盖所有年龄段,但倾向于40岁以上的女性。在转诊中,45%(452)来自普通外科医生,32%(327)来自家庭医生。24%(303)的推荐是空白的,1%(4)涉及风险-收益讨论。总共有109名(10.9%)的转介病人严格遵守指引;在宽松的方法下,30.6%(307)坚持。普通外科医生的粘连率高于妇科医生(32.8% [109]vs . 14.9% [109], P = 0.014)。结论和相关性。尽管有官方指导方针,但以色列的许多医生并没有按照建议对50岁以下的女性进行乳腺癌筛查,这凸显了循证医学与临床实践之间的差距。给50岁以下妇女的乳房x光筛查转诊是否遵循现行指南?在这项横断面研究中,随机选择了1287份推荐信样本,给予18至50岁的女性,当采用严格方法检查时,只有10.9%的人遵守指南,而采用宽容方法检查时,只有30.6%的人遵守指南。依从性与转诊医师的领域显著相关。尽管已知筛查性乳房x光检查存在风险,但50岁以下的女性通常会偏离现行指南进行此类筛查。
Screening Mammography for Young Women in Israel: Between Guidelines and Common Practice.
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.