Adding written recommendations to mammography reports does little to sway high-risk patients

Written recommendations being included with mammography reports have a minimal impact on high-risk patients’ likelihood of following up with a care provider, according to a study published in the Journal of the American College of Radiology.

The study was conducted by Alison L. Chetlen, DO, department of radiology at the Penn State Hershey Breast Center and Penn State Milton S. Hershey Medical Center in Hershey, Penn., and colleagues.

From 2011-2013, female patients ages 36-90 at high risk for breast cancer (National Cancer Institute lifetime risk of more than 20%) were identified by a team of radiologists. In 2011, the patients at high risk were referred to their appropriate providers, but there was no consistency to how this referral was carried out.

“Given that no risk assessment clinic was in place in the year 2011, and no specific, standardized, risk statement had been developed for the mammography reports, radiologists were inconsistent in the wording they used to write recommendations of referral for risk assessment and/or genetic testing,” the authors wrote.

In 2012, an official risk assessment program was established for patients. As a part of that program, a team of radiologists crafted a paragraph that would then be inserted into a high-risk patient’s mammography report and sent to their referring physician.

“This patient is noted to have higher than average risk for breast cancer due to family history and/or other risk factors,” the statement read. “We recommend a discussion between you and your patient regarding an evaluation with the Breast Center Risk Assessment Program. Additionally, patients with a lifetime relative risk of 20% or greater are known to benefit from additional screening modalities such as breast MRI.”

This risk assessment program brought new focus and clarity to the radiologists, giving them a specific protocol to follow. And throughout 2013, the radiologists followed this new protocol.

The authors then compared 2011’s data with 2013’s to see if the risk assessment program and written recommendation made any noticeable impact on getting patients to see a specialist.

And the verdict? The risk assessment program did lead to more recommendations from radiologists. The data shows that just over 40% (70 of 173) of patients were given a high-risk recommendation in 2011, before the program was in place. That number was over 75% (182 of 241) in 2013, after the program had been established.

However, the number of patients who visited a provider within one year of being given a high-risk recommendation did not show much of a change from 2011 to 2013, even after the established program and standardized written recommendation. A total of 11.4% of patients saw a provider after receiving the high-risk recommendation in 2011. That number was 14.2% in 2013.

These numbers, according to the authors, show that the written recommendation may have been a step in the right direction, but it did not have much of an overall impact.  

“Although this result demonstrates a positive trend, the increase between 2011 and 2013, in the percentage of patients who consulted with such a provider, was not statistically significant,” the authors wrote.

One factor to consider when considering these statistics, according to Chetlen and colleagues, is that a fear of cancer can sometimes lead to patients not following recommendations.

“High levels of psychological distress may contribute to decreased adherence to screening recommendations and guidelines in women identified as having a high risk for breast cancer,” the authors wrote.