Adherence to the United States Preventative Services Task Force Female Screening Guidelines: An Internal Medicine Residency Program Experience

Abstract

BackgroundVarious guidelines exist for female preventative screening tests and medical resident physician adherence to the United States Preventive Services Task Force (USPSTF) guidelines varies. National screening rates for breast cancer and osteoporosis have improved but they are still below the expected target.Material and methodsAmbulatory medical clinic records of female patients from the period July 2015 to December 2017 were reviewed for breast cancer and osteoporosis screening. Resident performance and commitment with regards to ordering the aforementioned screening tests according to the USPSTF guidelines were compared to the most recent national screening rates for mammograms and dual-energy X-ray absorptiometry (DXA) scans.ResultsOf the 1327 charts reviewed, 1025 was included in the study. Of the 545 mammograms performed, 93% of them were indicated according to the USPSTF guidelines (P < 0.0001, 95% CI: 125.9-342.0). A total of 480 mammograms were not ordered, of which 6% were indicated and 93.9% were not indicated. Out of a total of 107 DXA scans performed, 88.7% were correctly indicated (P < 0.0001, 95% CI: 37.11-132.9).ConclusionResident physician adherence to the USPSTF screening guidelines for breast cancer and DXA scans were higher than the national and state screening rates. Our well-structured educational project (strong faculty mentorship, resident to patient continuity of care and the reasonable resident-clinic load) resulted in higher screening rates.

A framework for personalized mammogram screening

“…As an immediate next step, we will focus on cross validating this data against participants' medical records. Further studies could incorporate medical record information from participants to track subsequent breast cancer diagnoses and adherence to breast cancer screening guidelines ( Corbelli et al, 2014 , Alvarez et al, 2019 ). This could provide longitudinal data to supplement current findings and examine how screening attendance may change as individual patients get older.…”

Critical gaps in knowledge and implementation of recommendations by the US Preventive Services Task Force

“…Implementation of USPSTF recommendations among physicians has been studied for individual recommendations, viz . : screening mammography ( Brooks, 2009 , Corbelli et al, 2014 , Alvarez et al, 2019 , Fung et al, 2015 ), breast cancer chemoprophylaxis ( Armstrong et al, 2006 ), lung cancer ( Henderson et al, 2017 ), cervical cancer screening ( Fung et al, 2015 ), diabetes screening ( Fung et al, 2015 ), cardiovascular disease/lipid disorders ( Fung et al, 2015 ), colon cancer screening ( Fung et al, 2015 ), alcohol use disorder ( Le, 2015 ), breast self-exam ( Loh, 2015 ), and osteoporosis ( Alvarez et al, 2019 , Powell et al, 2012 ). Much older work – e.g., Walsh and Papadakis in 1994 ( Walsh and Papadakis, 1994 ) – performed a then-comprehensive analysis, but we are aware of no recent comparative analysis of all 31 adult recommendations.…”