Are financial conflicts of interest influencing mammography recommendations?

Financial conflicts of interest (FCOIs) do not appear to impact or influence the development of consensus breast cancer screening recommendations, according to a new study published in the Journal of the American College of Radiology.

“One particular concern with guideline development is that the authors who produce them may have financial ties with drug and device companies that manufacture products relevant to guideline topics,” wrote Tyler Combs, Oklahoma State University in Tulsa, and colleagues. “These industry ties have the potential to influence the authors’ decision making and may potentially compromise the quality of patient care.”

Combs et al. examined current breast cancer screening guidelines from the U.S. Preventive Services Task Force (USPSTF), American Cancer Society, American College of Obstetricians and Gynecologists, International Agency for Research on Cancer, American College of Radiology and American College of Physicians. Payments from the industry for each guideline author were tracked using CMS data.

Overall, the team found, 33% of guideline authors did receive at least a single payment from within the industry. A total of 323 payments were discovered and analyzed. While 9% of the authors had one significant FCOI, 12% received more than $5,000 from a single company in one year. One author, meanwhile, had a significant FCOI that was not disclosed within the actual consensus guidelines themselves. The median total payments from all sources across all of the screening recommendations was $0.

Not all industry payments were directly connected to breast cancer screening, the authors added.

These findings are in “stark contrast,” the authors added, to previous research that found nearly 40% of all clinical practice guideline authors in healthcare had received more than $5,000 from a single company.

The researchers also explored the various reasons a breast radiologist, in theory, may care about consensus recommendations for breast cancer screening.

“Elimination of screening in women younger than 50 years and a shift to biannual screening in women older than 50 years would uniformly produce substantial decreases in revenue for many practices and potentially make breast radiology a financially unsustainable subspecialty choice,” the authors wrote. “If that scenario were to become reality, it is at least conceivable that a shift of upcoming talent away from breast radiology as a subspecialty could result in decreased detection rates of potentially concerning lesions in the hands of radiologists with less experience interpreting breast imaging studies. Conversely, but along the same thread, it must be considered that less robust screening recommendations advocated by organizations such as the USPSTF could theoretically be driven in part by influences from health care payer sources, whose true motives may be cost saving in nature but are presented under the guise of quaternary prevention or harm reduction.”

Overall, however, the authors said they saw no “compelling evidence” that FCOIs were more common among authors who recommend “earlier or more frequent screening.”