Columbia University Irving Medical Center, 161 Fort Washington Ave, New York, NY, 10032, USA.
Florida Atlantic University, Boca Raton, FL, USA.
BMC Cancer. 2022 Jul 27;22(1):819. doi: 10.1186/s12885-022-09900-x.
U.S. professional organizations have provided conflicting recommendations on annual vs. biennial mammography screening. Potential harms of more frequent screening include increased anxiety and costs of false positive results, including unnecessary breast biopsies and overdiagnosis.
To characterize current practices and beliefs surrounding mammography screening frequency and perspectives on using risk-based screening to inform screening intervals.
Semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR).
Patients, primary care providers (PCPs), third-party stakeholders (breast radiologists, radiology administrators, patient advocates).
Qualitative data, with a codebook developed based upon prespecified implementation science constructs.
We interviewed 25 patients, 11 PCPs, and eight key stakeholders, including three radiologists, two radiology administrators, and three patient advocates. Most patients reported having annual mammograms, however, half believed having mammograms every two years was acceptable. Some women were worried early breast cancer would be missed if undergoing biennial screening. PCPs were equally split between recommending annual and biennial mammograms. Although PCPs were interested in using breast cancer risk models to inform screening decisions, concerns raised include time burden and lack of familiarity with breast cancer risk assessment tools. All breast radiologists believed patients should receive annual mammograms, while patient advocates and radiology administrators were split between annual vs. biennial. Radiologists were worried about missing breast cancer diagnoses when mammograms are not performed yearly. Patient advocates and radiology administrators were more open to biennial mammograms and utilizing risk-based screening.
Uncertainty remains across stakeholder groups regarding appropriate mammogram screening intervals. Radiologists recommend annual mammography, whereas patients and PCPs were evenly split between annual vs. biennial screening, although both favored annual screening among higher-risk women. Breast cancer risk assessment tools may help facilitate decisions about screening intervals, but face barriers to widespread implementation in the primary care setting. These results will inform future implementation strategies to adopt risk-stratified breast cancer screening.
美国专业组织对年度和两年一次的乳房 X 光筛查提供了相互矛盾的建议。更频繁的筛查可能带来的危害包括增加焦虑和假阳性结果的成本，包括不必要的乳房活检和过度诊断。
描述当前围绕乳房 X 光筛查频率的实践和信念，以及使用基于风险的筛查来告知筛查间隔的观点。
受综合实施研究框架（CFIR）启发的半结构化访谈。
患者、初级保健提供者（PCP）、第三方利益相关者（乳房放射科医生、放射科管理人员、患者权益倡导者）。
定性数据，基于预先指定的实施科学结构制定了代码本。
我们采访了 25 名患者、11 名 PCP 和 8 名关键利益相关者，包括 3 名放射科医生、2 名放射科管理人员和 3 名患者权益倡导者。大多数患者报告每年进行乳房 X 光检查，但一半人认为每两年进行一次乳房 X 光检查是可以接受的。一些女性担心如果接受两年一次的筛查，早期乳腺癌会被遗漏。PCP 建议每年和每两年进行一次乳房 X 光检查的人数相当。尽管 PCP 对使用乳腺癌风险模型来告知筛查决策感兴趣，但提出的担忧包括时间负担和对乳腺癌风险评估工具不熟悉。所有的乳房放射科医生都认为患者应该每年接受乳房 X 光检查，而患者权益倡导者和放射科管理人员则在每年和每两年一次之间存在分歧。放射科医生担心如果不每年进行乳房 X 光检查，会遗漏乳腺癌诊断。患者权益倡导者和放射科管理人员对每两年进行一次乳房 X 光检查和使用基于风险的筛查更为开放。
利益相关者群体对适当的乳房 X 光筛查间隔仍然存在不确定性。放射科医生建议每年进行乳房 X 光检查，而患者和 PCP 在每年和每两年一次的筛查之间平均分配，但都赞成高风险女性每年进行筛查。乳腺癌风险评估工具可能有助于促进关于筛查间隔的决策，但在初级保健环境中广泛实施面临障碍。这些结果将为未来采用风险分层乳腺癌筛查的实施策略提供信息。
