Breast Cancer Screening Guidelines Research Articles

Trends in synchronous invasive ductal carcinomas of the breast: A SEER database analysis.

e13081 Background: Synchronous breast cancers are uncommon and account for around 2% of all breast cancer diagnosis. Lobular histology is considered a risk factor for synchronous breast cancers. We sought to study the trends in synchronous breast cancer of ductal histology and influence of age by interrogating the SEER database. Methods: The SEER Research data 1973-2013 was interrogated for synchronous infiltrating ductal carcinoma diagnosis (2 diagnosis within 6 months of each other). Overall survival (OS), the primary endpoint, was defined as the time (in months) from diagnosis to death from any cause. Univariate proportional hazards modeling results were used to assess the effect of age, race and stage on overall survival. All associations were considered statistically significant at an alpha error < 0.01. All analyses were performed using SAS version 9.4. Results: 1469 cases were identified. Data was categorized by age group: ≤ 65 years or > 65 years. 60% were 65 years or younger. 85% were Caucasians, 9.6% African Americans and 5.2% others. Younger women (≤ 65 years) had a statistically higher proportion of Stage III/IV breast cancer diagnosis as compared to older women (33.4% vs 25.2%; p = 0.002). The incidence rate of synchronous breast cancers has been rising since 1973, more pronounced in the older age group. Incidence rates overall have risen from 0.09/100,000 persons in 1973-1980 to 0.29/100,000 persons in 2001-2013 (p < 0.001). Incidence rates for synchronous breast cancer in women > 65 years has increased from 0.30/100,000 persons in 1973-1980 to 1.03/100,000 persons in 2001-2013. The adjusted OS among older women is significantly worse than that of younger women (HR 1.05; 95% CI 1.04-1.05; p < 0.001). Conclusions: Better imaging techniques and breast cancer screening guidelines have likely improved breast cancer detection rates thus leading to a rise in the incidence of synchronous breast cancers. It can be speculated that underlying medical problems and advanced age result in more morbidity and subsequent mortality in older women with standard treatment. The finding of more advanced disease among younger women deserves scrutiny as to cause.

Minnesota healthcare providers’ breast cancer screening practices at the extremes of age.

e13037 Background: Breast cancer screening guidelines disagree on the age to initiate and discontinue screening. We sought to determine the age at which Minnesota providers initiate and discontinue breast cancer screening. Methods: A cross-sectional online survey of Minnesota primary care providers was conducted in 2016. The survey queried providers’ breast screening practices for average-risk women. Data were summarized using descriptive statistics and comparisons by professional characteristics were conducted using Chi-squared tests. Results: There were 805 respondents (8% of 10,392 invitees), of which 456 (56.7%) provided primary care to women and were included in the analysis. 316 (72%) were women, 193 (44%) were physicians, 50 (11%) were physician assistants (PAs), and 197 (45%) were advanced practice nurses (APNs). 85% practiced in a community setting. 38% had practiced > 20 years, and 27% had practiced < 10 years. Among respondents, 67%, 77% and 72% recommended screening mammography for women age 40-44, 45-49 and 70+ years, respectively. Compared to male providers, female providers were more likely to screen women age 40-44 years (73% vs. 49%; p < 0.0001) and 45-49 years (81% vs. 66%; p = 0.002), but there was no difference by gender for patients age 70+ years (72% vs. 74%; p = 0.89). Respondents reporting specialized interest in women’s health were more likely to screen women age 40-44 years (73% vs. 61%; p = 0.006), 45-49 years (83% vs 72%; p = 0.007) and older than age 70 years (77% vs. 69%; p = 0.04). Physicians were less likely to screen women age 40-44 and 45-49 years (57% and 71%, respectively; p = 0.001) than PAs (72%, 78%) and APNs (74%, 83%), but APNs were less likely to screen women age 70+ years (65% vs. physicians 79% vs. PAs 76%; p = 0.006). Number of years in practice was not associated with a difference in age at initiation of screening, however, increasing number of years in practice was associated with screening women age 70+ years (p = 0.02). Conclusions: Although breast cancer screening practices for average risk women vary by healthcare provider characteristics, a majority of Minnesota primary care providers initiate breast cancer screening between ages 40-49 years, and continue screening women age 70 years and older.

Adaptive decision-making of breast cancer mammography screening: A heuristic-based regression model

The American Cancer Society (ACS) updated their breast cancer screening guidelines in late 2015 and recommends that all women have the choice to start annual mammography screenings beginning at age 40. For women ages 45–54, the ACS explicitly recommends annual mammograms. However, due to the potential harms associated with screening mammography, such as overdiagnosis and unnecessary work-ups, the best strategy to design an appropriate breast cancer mammography screening schedule remains controversial. Instead of recommending a one-size-fits-all screening schedule, this study identifies a personalized mammography screening strategy adaptive to each woman's age-specific breast cancer risk. We present a two-stage decision framework: (1) age-specific breast cancer risk estimation and (2) annual mammography screening decision-making based on estimated risk. The results suggest that the optimal combinations of independent variables used in risk estimation are not the same across age groups. Our optimal decision models outperform the existing mammography screening guidelines in terms of the average loss of life expectancy. While most earlier studies improved the breast cancer screening decisions by offering lifetime screening schedules, our proposed model provides an adaptive screening decision aid by age. Since whether or not a woman should receive a mammogram is determined based on her breast cancer risk at her current age, our “on-line” screening policy adapts to a woman's latest health status, which reflects the current individual risk of each woman more accurately.

Physician Nonadherence to Breast Cancer Screening Guidelines

Breast cancer screening guidelines from the American College of Obstetricians and Gynecologists (ACOG; NEJM JW Womens Health Aug 2011 and Obstet

Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women.

Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.

Use of patient decision aids increased younger women's reluctance to begin screening mammography: a systematic review and meta-analysis.

As breast cancer screening guidelines have changed recently, additional investigation is needed to understand changes in women's behavior after using breast cancer screening patient decision aids (BCS-PtDAs) and the potential effect on mammography utilization. This systematic review and meta-analysis sought to evaluate the effect of BCS-PtDAs on changes in women's intentions to undergo screening mammography and whether women deciding to begin or discontinue screening mammography displayed similar changes in screening intentions after using a BCS-PtDA. We searched Medline, Scopus, PsycINFO, CENTRAL, Health and Psychosocial Instruments, Health Technology Assessment Database, PsycARTICLES, and cited references in eligible papers for randomized controlled trials (RCTs) and observational studies, published through August 24, 2016. The proportions of women who did and not intend to undergo screening and who were uncertain about undergoing screening mammography were pooled, using risk ratios (RR) and random effects. According to the protocol, RCTs or observational studies and any language were considered eligible for systematic review if they included data about women for which shared decision making is recommended. We ultimately included six studies with screening intention data for 2040 women. Compared to usual care, the use of BCS-PtDAs in three RCTs resulted in significantly more women deciding not to undergo screening mammography (RR 1.48 [95% CI 1.04-2.13]; P = 0.03), particularly for younger (38-50 years) women (1.77 [1.34-2.34]; P < 0.001). The use of BCS-PtDAs had a non-significant effect on the intentions of older women (69-89 years) to discontinue screening. The use of BCS-PtDAs increased younger women's reluctance to undergo screening for breast cancer. The implementation of such BCS-PtDAs in clinical practice would be expected to result in a 77% increase in the number of younger women (aged 38-50) who do not intend to be screened, and as a consequence, may reduce utilization of screening mammography. The protocol of this review is registered in the PROSPERO database, #CRD42016036695.

Abstract P5-08-16: Breast cancer in the Bahamas: Revisiting the adequacy of national screening guidelines

Abstract Background: The Bahamas is an island nation shown to have a high incidence of early onset breast cancer. In addition, recent research has revealed that the Bahamian population has a high prevalence of a founder mutation to the BRCA1 gene. Despite the population differences between the Bahamas and the United States, the screening guidelines for breast cancer in the Bahamas reflect those of the United States. This study provides data that suggests that the current breast cancer screening guidelines in the Bahamas do not capture cases in the age groups most at risk and are in need of revision. Methods: We performed a retrospective review of all cases submitted to the Princess Margaret Hospital cancer registry from 1998-2012. We divided the patients into 10 year age cohorts and determined the frequency of breast cancer in each group. For comparison, data for the United States was obtained using the Surveillance, Epidemiology, and End Results (SEER) 18 registries, including all cases of breast cancer from 1998-2012 further stratified into age groups and ethnicity. Results: The average age of diagnosis of breast cancer in the Bahamas from 1998-2012 was 54 years, compared to an average age of diagnosis in the United States overall population of 61 years and among the black American ethnicity, 58 years (2008-2012 data). The age group with the highest percentage of incidence in the Bahamas is the 40-49 age group consisting of 27% of those diagnosed from 1998-2012. During the same time period, the age group with the highest incidence of breast cancer in the United States was the 50-59 age group in the overall population (24.8%), as well as in the black population (26.7%). By beginning screening at age 40, according to screening guidelines during the study period, the United States was able to capture 95.3% of breast cancer cases in the overall population and 92.8% of breast cancer cases in the black population. Using similar guidelines, the Bahamas captured only 83.6% of breast cancer cases. For comparison, if screening began at age 30 in the Bahamas during the study period, 97% of breast cancer cases would have been captured. Conclusions: The data in this study demonstrates significant differences in the incidence of breast cancer between age group cohorts in the population of the Bahamas compared to the population of the United States. Furthermore, it suggests that the screening guidelines in place in the Bahamas may be insufficient at capturing an adequate percentage of the population at risk for breast cancer. A significant increase in capture of those with breast cancer in the Bahamas may be achieved by reducing the age to begin screening below the age of 40. Citation Format: Deleveaux S, Curling D, Francis W. Breast cancer in the Bahamas: Revisiting the adequacy of national screening guidelines [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-16.

Abstract ES5-1: Breast cancer risk assessments: Who is high risk?

Abstract What is my risk for breast cancer? This is a common question physicians are asked, and with the changing guidelines for breast cancer screening it is very important to have a good understanding of what a woman's risk for breast cancer is. Breast cancer risk assessments can be done based on family history, risk factors and personal history of prior breast biopsies. During this educational session we will review different models used to determine breast cancer risk as well as other factors that can increase or reduce breast cancer risk. Citation Format: Nangia J. Breast cancer risk assessments: Who is high risk? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr ES5-1.

Abstract P5-03-05: Development of a panel of serum-based protein biomarkers for the non-invasive detection of breast cancer in BI-RADS category 4 patients

Abstract Background: Current breast cancer screening guidelines call for annual mammography for asymptomatic women age 45 to 54 and once every two years for women age 55 and older. Women with suspicious screening mammograms are recommended for a diagnostic mammogram and may also undergo MRI or ultrasound. Ultimately, suspicious findings unresolved by imaging typically result in the recommendation of a breast biopsy. Approximately 10% of suspicious diagnostic mammograms are recommended for breast biopsies and 67% to 95% of these biopsies yield negative results. With the goal of reducing the number of patients with benign pathology undergoing invasive biopsies, we conducted a screen for serum protein biomarkers and identified a novel panel for the non-invasive detection of breast cancer. Methods: Serum samples were collected at two sites from women with suspicious diagnostic mammogram findings (primarily BI-RADS category 4) undergoing biopsy for the evaluation of a potential malignancy. Serum samples from 100-patients (50 benign pathology and 50 malignant pathology) were evaluated on the SOMAscan Assay 1.3k, which measures levels of 1,310 different protein analytes. Statistical screening methodologies, such as individual t-tests with control for false discovery, were used to identify markers with the potential to distinguish benign from malignant pathology. The candidate markers were further studied and combined using generalized linear modeling to develop three potential diagnostic models. K-fold cross validation was used to guard against over fitting of the models. Results: A 15-marker model resulted in an AUC of 0.92 with a sensitivity of 90% and specificity of 76%. Two 6-marker models (with 4 markers in common) each resulted in AUC of 0.85, yielding a sensitivity of 90% with a specificity of 56% or 64%. Conclusions: This study reveals a novel panel of serum protein biomarkers that may allow for the non-invasive and sensitive detection of breast cancer in BI-RADS category 4 patients. A multicenter study is underway to further refine and validate this panel in a larger set of prospectively collected patient samples. Citation Format: Chapman KB, Copeland K, Kidd J, Qiu L, Sheibani N, Tam O, Friedman L, Korn R, Fiorica J, Lourenco A, Suthers S, Hesterberg L. Development of a panel of serum-based protein biomarkers for the non-invasive detection of breast cancer in BI-RADS category 4 patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-03-05.

Psychological Distress and the Use of Clinical Preventive Services by Community-Dwelling Older Adults.

In this study, we explored whether psychological distress plays a role in the use of recommended clinical preventive services among community-dwelling older adults. The sample is drawn from respondents 65 years and older who participated in the 2011 Medical Expenditure Panel Survey (MEPS). Logistic regressions with selected covariates were entered in the model to estimate odds ratios (OR) with 95% confidence interval (CI) for the independent effect of psychological distress on the utilization of each of five preventive services. With the exception of breast cancer screening where the uptake of preventive services was significantly lower for older adults with psychological distress (OR = 0.57, p < .001), uptake of other key preventive measures revealed no significant utilization differences between older adults with and without psychological distress. The results suggest that adherence to breast cancer screening guidelines may be increased by improving recognition and treatment of emotional health problems in older women.

Breast Cancer Screening and Social Media: a Content Analysis of Evidence Use and Guideline Opinions on Twitter.

There is ongoing debate regarding the best mammography screening practices. Twitter has become a powerful tool for disseminating medical news and fostering healthcare conversations; however, little work has been done examining these conversations in the context of how users are sharing evidence and discussing current guidelines for breast cancer screening. To characterize the Twitter conversation on mammography and assess the quality of evidence used as well as opinions regarding current screening guidelines, individual tweets using mammography-related hashtags were prospectively pulled from Twitter from 5 November 2015 to 11 December 2015. Content analysis was performed on the tweets by abstracting data related to user demographics, content, evidence use, and guideline opinions. Standard descriptive statistics were used to summarize the results. Comparisons were made by demographics, tweet type (testable claim, advice, personal experience, etc.), and user type (non-healthcare, physician, cancer specialist, etc.). The primary outcomes were how users are tweeting about breast cancer screening, the quality of evidence they are using, and their opinions regarding guidelines. The most frequent user type of the 1345 tweets was "non-healthcare" with 323 tweets (32.5%). Physicians had 1.87 times higher odds (95% CI, 0.69-5.07) of providing explicit support with a reference and 11.70 times higher odds (95% CI, 3.41-40.13) of posting a tweet likely to be supported by the scientific community compared to non-healthcare users. Only 2.9% of guideline tweets approved of the guidelines while 14.6% claimed to be confused by them. Non-healthcare users comprise a significant proportion of participants in mammography conversations, with tweets often containing claims that are false, not explicitly backed by scientific evidence, and in favor of alternative "natural" breast cancer prevention and treatment. Furthermore, users appear to have low approval and confusion regarding screening guidelines. These findings suggest that more efforts are needed to educate and disseminate accurate information to the general public regarding breast cancer prevention modalities, emphasizing the safety of mammography and the harms of replacing conventional prevention and treatment modalities with unsubstantiated alternatives.

한국 여성의 비만과 체형인식왜곡에 따른 유방암 검진율 차이

Purpose: This study was performed to elucidate whether the obesity or body image is a barrier to breast screening compliance in Korean women. Methods: We included 54,017 women aged between 35 to 70 years from the Korea Community Health Survey (KCHS) 2014 dataset. To identify whether a mutual relationship exists between weight perceptions and breast cancer screening rates, the participants were divided into three groups according to the level of concordance between Body Mass Index (BMI) and a subjective body image. Descriptive analyses, a chi-square test, and multivariate logistic regression analyses were performed. Results: After covariate adjustment, the screening rate of the overweight group was 1.09 times higher than the normal weight group (odds ratio [OR], 1.09; confidence interval [CI], 0.00-0.16; p=.038) and the severe obesity group was 1.20 times lower (OR, 0.83; CI, -0.36-0.00; p=.047). Weight misperception also had a significant influence on breast cancer screening. Especially, The overweight distortion group was less likely to undergo breast cancer screening (OR, 0.93; CI, -0.15-0.00; p=.037). Conclusion: Obesity and weight misperceptions are associated with lower compliance with breast cancer screening guidelines. Key Words: Breast neoplasms; Mammography; Obesity; Body mass index; Weight perception Key Words: ìœ ë°©ì•”; ìœ ë°© ì´¬ì˜ìˆ ; 비만; 체질량 지수; 체형인식왜곡

Primary Care Providers' Beliefs and Recommendations and Use of Screening Mammography by their Patients.

Revised breast cancer screening guidelines have fueled debate about the effectiveness and frequency of screening mammography, encouraging discussion between women and their providers. To examine whether primary care providers' (PCPs') beliefs about the effectiveness and frequency of screening mammography are associated with utilization by their patients. Cross-sectional survey data from PCPs (2014) from three primary care networks affiliated with the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, linked with data about their patients' mammography use (2011-2014). PCPs (n = 209) and their female patients age 40-89 years without breast cancer (n = 30,233). Outcomes included whether (1) women received a screening mammogram during a 2-year period; and (2) screened women had >1 mammogram during that period, reflecting annual screening. Principal independent variables were PCP beliefs about the effectiveness of mammography and their recommendations for screening frequency. Overall 65.2% of women received >1 screening mammogram. For women 40-48 years, mammography use was modestly lower for those cared for by PCPs who believed that screening was ineffective compared with those who believed it was somewhat or very effective (59.1%, 62.3%, and 64.7%; p = 0.019 after controlling for patient characteristics). Of women with PCPs who reported they did not recommend screening before age 50, 48.1% were nonetheless screened. For women age 49-74 years, the vast majority were cared for by providers who believed that screening was effective. Provider recommendations were not associated with screening frequency. For women ≥75years, those cared for by providers who were uncertain about effectiveness had higher screening use (50.7%) than those cared for by providers who believed it was somewhat effective (42.8%). Patients of providers who did not recommend screening were less likely to be screened than were those whose providers recommended annual screening, yet 37.1% of patients whose providers recommended against screening still received screening. PCP beliefs about mammography effectiveness and screening recommendations are only modestly associated with use, suggesting other likely influences on patient participation in mammography.

Breast Cancer Screening for High-Risk Patients of Different Ages and Risk - Which Modality Is Most Effective?

While the guidelines for breast cancer screening in average-risk women are well established, screening in high-risk women is not as clear. For women with BRCA1 or BRCA2 mutations, current guidelines recommend screening by clinical breast examination and mammography starting at age 30. For certain high-risk women, additional screening with magnetic resonance imaging (MRI) is encouraged. This review focuses on differentiating imaging modalities used for screening women at high-risk for breast cancer over the age of 50 by discussing the different imaging techniques, cost versus benefit, detection rates, and impact on survival. While mammography is the only imaging modality proven to reduce mortality from breast cancer, MRI is more sensitive in identifying cancers. MRI can often identify smaller malignancies at a greater resolution at an earlier stage. The use of MRI would be more cost effective as there would be less need for invasive therapeutic procedures. Research thus far has not identified an age-specific preference in imaging modality. There are no guidelines for high-risk women that specify screening with respect to age (i.e., older than 50 years old). More research is needed before screening guidelines in different age groups with various risk factors can be established.

The Impact of Primary Care Providers on Patient Screening Mammography and Initial Presentation in an Underserved Clinical Setting.

Cancer screening is a key component of primary care, and access to regular screening mammography (SMG) is highly dependent on recommendation and referral by a primary care provider (PCP). Women with no health insurance or who are underinsured often lack access to a regular PCP and thus access to routine screening. We retrospectively reviewed the charts of 173 surgical patients diagnosed between January 2012 and December 2013. The main outcome variables were PCP status, method of cancer detection, and breast cancer stage at diagnosis. Additional variables included race, age at diagnosis, family history of breast and ovarian cancer, and medical comorbidities. Patients with a PCP received more mammograms (SMG) compared with patients without a PCP (61 vs. 37%; p=0.003). The majority (73%) of patients without a PCP presented symptomatically with a palpable mass versus 42% of patients with a PCP. A significant difference was noted with regard to final pathologic stage of breast cancer between the two groups (p=0.019), and Caucasian and African American patients were more likely to have locally advanced breast cancer. Underserved patients with a PCP are more likely to present asymptomatically and at an earlier stage of breast cancer compared with patients without a PCP. Community engagement programs that build relationships with patients may help bring vulnerable patients into the healthcare system for routine screening. Moreover, PCP education regarding the subtleties of breast cancer screening guidelines and referral to a breast specialist is also critical in improving outcomes of underserved patients.

Lay Epistemology of Breast Cancer Screening Guidelines Among Appalachian Women

ABSTRACTRecent changes to the U.S. Preventive Services Task Force guidelines for breast cancer screening have contributed to increased patient uncertainty regarding the timing and appropriateness of screening behaviors. To gain insight into the lay epistemology of women regarding breast cancer screening practices, we conducted in-depth, face-to-face interviews with 24 adult women living in a medically underserved Appalachian region. We found that women were unaware of breast cancer screening guidelines (i.e., start age, frequency, stop age). Qualitative analysis revealed two lay epistemological narratives establishing (a) uncertain knowledge and ambiguity about breast cancer screening guidelines but certain knowledge of other women’s experiences with breast cancer diagnoses, and (b) feelings of knowing one’s own body best and seeing the value in “overscreening” to save even one life. Our findings have theoretical and practical implications for scholars and practitioners seeking to improve knowledge or behavior regarding adherence to breast cancer screening recommendations.

Review of the New American Cancer Society Guidelines for Breast Cancer Screening for Women at Average Risk

Review of the New American Cancer Society Guidelines for Breast Cancer Screening for Women at Average Risk

Promoting breast health education, Access and screening mammography for women with Cultural and financial barriers: A community engagement and outreach project in the city of milwaukee,Wisconsin (USA).

e18060Background: Access and adherence to breast cancer screening guidelines is challenging for women with language, cultural, and financial barriers. We partnered with several community sites in t...

Heterogeneity in Women’s Adherence and Its Role in Optimal Breast Cancer Screening Policies

Most major health institutions recommend women to undergo repeat mammography screening for early diagnosis of breast cancer, the leading cause of cancer deaths among women worldwide. Although the proportion of women who ever had a mammogram is increasing, a majority of women do not get repeat mammograms. This paper analyzes the role of heterogeneity in women’s adherence on optimal mammography screening recommendations. We develop a dynamic modeling framework that considers imperfect and heterogeneous adherence to screening recommendations. We carefully calibrate our model and solve it using real data. Unlike the existing breast cancer screening guidelines, our results suggest that adherence and heterogeneity in women’s adherence behaviors should be explicitly considered. In particular, we find that when screening strategies are optimized assuming average adherence for everyone, the effect on patients with already low adherence would be relatively small, but patients with high adherence would be adversely affected. Considering imperfect and heterogeneous adherence in the population, our model suggests (1) given the current low adherence rates, an aggressive screening policy such as annual screening between the ages of 40 and 79 should be promoted to the general population; (2) screening strategies may be adjusted in clinical practice based on women’s adherence, and screening intervals can be extended to two years for women with a history of high adherence; and (3) if the screening patterns change in the long run and most regular screeners adopt the most recent U.S. Preventive Services Task Force guidelines, then improving overall mammography adherence in society becomes more critical. This paper was accepted by Rakesh Sarin, decision analysis.

Impact of Changes to Breast Cancer Screening Guidelines on Healthcare Providers and Patients.

In October 2015, the American Cancer Society (ACS) updated its evidence-based breast cancer screening guidelines for women at average risk for breast cancer. These guidelines introduced significant changes to the age to begin breast cancer screening, as well as the frequency between screenings and duration of screening. Not long afterward, in January 2016, the U.S. Preventive Services Task Force released its updated breast cancer screening guidelines, which differ from those of the ACS. The varying guidelines present challenges for healthcare providers and patients, particularly women aged 40-49 years.