title: Alignment of breast cancer screening guidelines, accountability metrics, and practice patterns.
abstract: OBJECTIVE
  Breast cancer screening guidelines and metrics are inconsistent with each other and may differ from breast screening practice patterns in primary care. This study measured breast cancer screening practice patterns in relation to common evidence-based guidelines and accountability metrics.
  
  
  METHODS
  Cohort study using primary data collected from a regional breast cancer screening research network between 2011 and 2014.
  
  
  METHODS
  Using information on women aged 30 to 89 years within 21 primary care practices of 2 large integrated health systems in New England, we measured the proportion of women screened overall and by age using 2 screening definition categories: any mammogram and screening mammogram.
  
  
  RESULTS
  Of the 81,352 women in our cohort, 54,903 (67.5%) had at least 1 mammogram during the time period, 48,314 (59.4%) had a screening mammogram. Women aged 50 to 69 years were the highest proportion screened (82.4% any mammogram, 75% screening indication); 72.6% of women at age 40 had a screening mammogram with a median of 70% (range = 54.3%-84.8%) among the practices. Of women aged at least 75 years, 63.3% had a screening mammogram, with the median of 63.9% (range = 37.2%-78.3%) among the practices. Of women who had 2 or more mammograms, 79.5% were screened annually.
  
  
  CONCLUSIONS
  Primary care practice patterns for breast cancer screening are not well aligned with some evidence-based guidelines and accountability metrics. Metrics and incentives should be designed with more uniformity and should also include shared decision making when the evidence does not clearly support one single conclusion.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
authors.forename: Charles
authors.initials: C
authors.lastname: Brackett
authors.forename: Julie
authors.initials: J
authors.lastname: Weiss
authors.affiliation: Geisel School of Medicine at Dartmouth, 1 Medical Center Dr, Lebanon, NH 03756. E-mail: Martha.e.goodrich@dartmouth.edu.
authors.forename: Martha
authors.initials: M
authors.lastname: Goodrich
authors.forename: Kimberly
authors.initials: K
authors.lastname: Harris
authors.forename: Steve
authors.initials: S
authors.lastname: Pyle
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods / Q000592:standards*; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012941:Social Responsibility