Conflicting and changing breast cancer screening recommendations: survey study of a national sample of ob-gyns after the release of the 2009 USPSTF guidelines

J Healthc Qual. 2013 Jul-Aug;35(4):25-35. doi: 10.1111/jhq.12009. Epub 2013 Apr 16.


Objective: To assess obstetrician-gynecologists' (ob-gyns') use of multiple conflicting guidelines assess after the release of the 2009 U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations.

Study design: A nationally representative sample of American College of Obstetricians and Gynecologists (ACOG) Fellows were invited to complete a survey.

Results: A total of 235 of 399 ob-gyns responded (59% response rate). Twenty percent and 89% indicated that USPSTF and ACOG guidelines influence their practice, respectively, 84% are influenced by more than one guideline. The plurality of respondents was able to correctly identify ACOG and USPSTF guidelines on 10 of 12 questions. One-third agreed with both ACOG's and USPSTF's recommendations regarding mammography screening for women 40-49 years old. A total of 42% of the sample made at least one change in their practice after the release of the 2009 USPSTF breast cancer screening guidelines.

Conclusion: Some ob-gyns made changes to their practices after the release of the USPSTF guidelines. When multiple guidelines exist, as in the case with breast cancer screening, physicians utilize multiple, and at times conflicting, guidelines. More research will be needed to better understand the impact (negative or positive) of multiple guidelines on the quality of healthcare.

Keywords: breast cancer; evidence-based practice/guidelines; health promotion and screening; research quantitative.

MeSH terms

  • Adult
  • Age Factors
  • Attitude of Health Personnel*
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / prevention & control
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / standards
  • Early Detection of Cancer / trends
  • Female
  • Guideline Adherence / statistics & numerical data
  • Guideline Adherence / trends
  • Gynecology / standards*
  • Gynecology / statistics & numerical data
  • Gynecology / trends
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Logistic Models
  • Male
  • Mammography / standards*
  • Mammography / trends
  • Middle Aged
  • Obstetrics / standards*
  • Obstetrics / statistics & numerical data
  • Obstetrics / trends
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Practice Patterns, Physicians' / trends
  • Societies, Medical / standards
  • Societies, Medical / trends
  • United States