{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T01:58:08Z","timestamp":1767664688573,"version":"3.48.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["MDM Policy & Practice"],"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Background.<\/jats:bold>\n Breast cancer screening via mammography for women younger than 50 y sparks controversy due to balancing benefits and risks. In Israel, specific criteria govern early screening initiation, yet global studies reveal low adherence to guidelines for this demographic.\n Objectives.<\/jats:bold>\n This study aims to report on young women\u2019s referrals for screening mammography in Israel, assess adherence to guidelines, and identify factors influencing guideline adherence.\n Design, Setting, and Participants.<\/jats:bold>\n A cross-sectional study analyzed referral letters for screening mammography issued to women aged 18 to 49 y from March 2019 to February 2020 in 2 districts of Israel\u2019s largest health care provider. Exclusions included women with a history of breast cancer or BRCA mutations. Of 9,960 letters, 1,287 were randomly selected for adherence assessment, with 13% of nonadherent cases further reviewed.\n Main Outcomes and Measures.<\/jats:bold>\n Primary outcomes included categorizing referrals as adherent or nonadherent to guidelines. Additional measures explored correlations between adherence and patient characteristics (e.g., age, comorbidities) and the referring physician\u2019s specialty.\n Results.<\/jats:bold>\n A total of 999 referral letters were included in the statistical analysis. Referrals spanned all ages but skewed toward women older than 40 y. Of the referrals, 45% (452) came from general surgeons and 32% (327) from family physicians. Twenty-four percent (303) of referrals were blank, and 1% (4) involved risk\u2013benefit discussions. In total, 109 (10.9%) of the referrals strictly adhered to guidelines; under a lenient approach, 30.6% (307) adhered. General surgeons adhered more frequently than gynecologists did (32.8% [109] v. 14.9% [11],\n P<\/jats:italic>\n = 0.014).\n Conclusions and Relevance.<\/jats:bold>\n Despite official guidelines, many physicians in Israel did not follow recommendations for breast cancer screening in women younger than 50 y, highlighting a gap between evidence-based medicine and clinical practice.\n <\/jats:p>\n \n Highlights<\/jats:title>\n \n \n \n Question<\/jats:bold>\n <\/jats:p>\n Are screening mammography referrals, given to women younger than 50\u2009y of age, adherent to current guidelines?<\/jats:p>\n <\/jats:list-item>\n \n \n Findings<\/jats:bold>\n <\/jats:p>\n In this cross-sectional study of a randomly selected sample of 1,287 referral letters, given to women aged 18 to 50 y, only 10.9% were adherent with the guidelines when examined with a strict approach and 30.6% with a forgiving approach. Adherence significantly correlated with the field of the referring physician.<\/jats:p>\n <\/jats:list-item>\n \n \n Meaning<\/jats:bold>\n <\/jats:p>\n Despite known risks of screening mammography, women younger than 50\u2009y are commonly referred to such screening in a deviation from current guidelines.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1177\/23814683251317524","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T08:12:47Z","timestamp":1741767167000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Screening Mammography for Young Women in Israel: Between Guidelines and Common Practice"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3269-0248","authenticated-orcid":false,"given":"Neta","family":"Essar Schvartz","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Clalit Health Services, Haifa District, Haifa, Israel"},{"name":"The Technion - Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2362-330X","authenticated-orcid":false,"given":"Michal","family":"Rotem-Green","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Clalit Health Services, Haifa District, Haifa, Israel"},{"name":"The Technion - Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dikla","family":"Kruger","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Clalit Health Services, Haifa District, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anat","family":"Gaver","sequence":"additional","affiliation":[{"name":"Clalit Health Services, Dan PT District, Israel"},{"name":"Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Inbar","family":"Safra","sequence":"additional","affiliation":[{"name":"Clalit Health Services, Dan PT District, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle Mira","family":"Harari","sequence":"additional","affiliation":[{"name":"Clalit Health Services, Dan PT District, Israel"},{"name":"Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadav","family":"Niego","sequence":"additional","affiliation":[{"name":"The Technion - Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mordechai","family":"Alperin","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Clalit Health Services, Haifa District, Haifa, Israel"},{"name":"The Technion - Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.3388"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2886"},{"key":"e_1_3_3_4_2","unstructured":"U.S. Preventive Services Task Force. Breast cancer screening: final recommendation statement. Available from: https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/breast-cancer-screening#bcei-recommendation-title-area. [Accessed 17 August 2024]."},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002158"},{"key":"e_1_3_3_6_2","unstructured":"National Comprehensive Cancer Network. Breast cancer screening and diagnosis. Available from: https:\/\/www.nccn.org\/patients\/guidelines\/content\/PDF\/breastcancerscreening-patient.pdf"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.13183"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-15-0803"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1401875"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.20452\/pamw.895"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1206809"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600249"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.2247"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.2445"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.16784"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.160"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1466"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/02813432.2018.1523985"},{"key":"e_1_3_3_19_2","unstructured":"Ministry of Health. Recommendations of the Committee for the Assessment of the National Breast Cancer Screening Programme. Available from: https:\/\/www.health.gov.il\/NewsAndEvents\/SpokemanMesseges\/Documents\/10022019_1_1.pdf. [Accessed 14 October 2019]."},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.0453"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2018.7436"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2017.11.010"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.0458"},{"key":"e_1_3_3_24_2","unstructured":"Ministry of Health. Rational use of drugs by elders. Available from: https:\/\/www.health.gov.il\/PublicationsFiles\/Rational_use_of_drugs_By_Elders.pdf. [Accessed 20 May 2020]."},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X18823757"},{"key":"e_1_3_3_26_2","unstructured":"The State Comptroller and Ombudsman of Israel. Report on medical malpractice claims 2012. Available from: https:\/\/www.mevaker.gov.il\/he\/Reports\/Report_117\/4f532afa-81a1-4e4d-81b3-6512df99272f\/7528.docx. 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