Hidradenitis suppurativa, often abbreviated HS, is a chronic, debilitating inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels known as sinus tracts, typically developing in intertriginous areas where skin rubs against skin. It affects an estimated one percent or more of the population, with women disproportionately affected, and it is far more than a cosmetic nuisance. Patients endure flares that can last decades, scarring that limits movement, and a psychological burden that includes elevated rates of depression and anxiety. The disease is also increasingly recognized as systemic: it is associated with metabolic syndrome, cardiovascular disease, inflammatory arthritis, and other comorbidities that suggest the inflammation driving HS does not respect the boundaries of the skin.

Against that backdrop, the Henry Ford team, led by Albert T. Young and including colleagues Alexandra Turfe, Meyer Gershater, Umer Nadir, Mulin Xiong, Li Zhou, and Qing-Sheng Mi, asked a deceptively simple question: do patients with hidradenitis suppurativa adhere to breast cancer screening guidelines at the same rate as comparable women without the disease? Breast cancer remains one of the most common cancers among women in the United States, and organizations such as the American Cancer Society have long issued screening recommendations, generally centered on regular mammography beginning in middle age, because early detection dramatically improves survival. Screening adherence is therefore one of the most closely watched metrics in preventive care, and gaps in adherence are a well-documented driver of cancer disparities.

The study design was a retrospective cohort analysis, a method that mines years of real-world clinical data rather than following patients forward in time. The researchers drew on the medical records of a large, diverse health care system in Detroit, an institution whose patient population includes substantial numbers of Black patients, a group that bears a disproportionate burden of both hidradenitis suppurativa and aggressive breast cancer. By identifying age-eligible women with a documented HS diagnosis and comparing their screening behavior against appropriate comparison groups, the team could ask whether the disease itself, or the circumstances surrounding it, correlates with missed mammograms. Retrospective designs of this kind cannot prove causation, but they are powerful for detecting patterns that would take years and enormous budgets to capture prospectively.

There are several plausible reasons to suspect that women with HS might fall behind on screening. The disease’s physical symptoms can make mammography genuinely uncomfortable or painful, since the procedure involves compressing the breast tissue, and HS lesions frequently occur in the inframammary fold and axillae. Flares of abscesses and draining tunnels may make patients reluctant to schedule any procedure involving the chest wall. Beyond the mechanical barriers, HS patients face well-documented delays in diagnosis, stigma in clinical settings, and a fragmented care experience in which dermatology, primary care, and specialty services operate in separate silos. A patient whose medical visits are consumed by managing painful flares may have little bandwidth for preventive care that addresses a risk that feels distant.

The broader literature on screening adherence reinforces why this question matters. Large national surveys, including analyses of the National Health Interview Survey, have shown that even among age-eligible women in the general population, adherence to breast cancer screening guidelines falls well short of universal, with substantial variation by race, income, insurance status, and access to a usual source of care. Any chronic disease that adds friction to the health care experience, whether through pain, stigma, or logistical burden, has the potential to widen those gaps further. Conversely, identifying a specific population at elevated risk of under-screening creates a concrete target for intervention, from reminder systems to coordinated care pathways that bundle preventive services into dermatology visits.

The Detroit study is notable not only for its question but for its setting. Henry Ford Health maintains one of the country’s most extensive longitudinal databases on hidradenitis suppurativa, and the same group previously published a retrospective cross-sectional analysis of more than 13,000 HS patients drawn from health system records spanning nearly three decades, from 1995 to 2022. That earlier work helped establish the demographic and comorbidity profile of a diverse HS cohort in the United States, and it provided the methodological scaffolding for the current investigation. The new study was supported by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health, reflecting a sustained federal investment in a disease that was, until relatively recently, chronically underfunded and understudied.

The research also fits into a wider effort to map the full systemic footprint of hidradenitis suppurativa in women’s health. The same Detroit group and collaborators have previously examined pregnancy outcomes in HS patients and surveyed patients about breastfeeding decisions, work that revealed how the disease and its treatments intersect with reproductive choices in ways that clinicians rarely discuss. Breast cancer screening is a natural extension of that agenda: it concerns the same anatomical region, the same patient population, and the same underlying question of whether a stigmatized, painful, chronic disease quietly reshapes the preventive care a woman receives. If screening rates among HS patients lag behind guidelines, the finding would add a new dimension to the growing list of health disparities associated with the condition.

For clinicians, the practical implications of this line of research are straightforward even before the results are translated into practice. Dermatologists, who often serve as the primary point of contact for HS patients, are well positioned to ask about mammography during routine visits and to coordinate referrals, particularly because many patients with moderate to severe HS see their dermatologist more frequently than their primary care physician. Health systems can embed screening reminders into dermatology workflows, and radiology departments can offer accommodations, such as scheduling flexibility around flares or additional pain management, that make mammography more feasible for patients whose disease makes compression especially uncomfortable. None of these interventions requires new technology; they require only the recognition that a skin disease can create barriers to cancer detection.

The study, published as a research letter in the Archives of Dermatological Research with the Henry Ford Health institutional review board’s approval, is a reminder of how much remains unknown about the everyday health care experiences of people with chronic inflammatory skin disease. Hidradenitis suppurativa affects millions of people worldwide, yet its influence on routine preventive care has only begun to be quantified. As the evidence base grows, the hope is that screening gaps, wherever they exist, can be closed with targeted, practical measures, and that patients with HS will no longer have to choose between managing the disease they can see and preventing the one they cannot. The findings arrive at a moment when the dermatology community is increasingly committed to treating HS not as an isolated skin complaint but as a systemic condition with consequences that reach into every corner of a patient’s medical life, including the quiet, life-saving work of cancer screening.

Subject of Research: Breast cancer screening adherence among patients with hidradenitis suppurativa

Article Title: Adherence to breast cancer screening guidelines among patients with hidradenitis suppurativa: a retrospective cohort study

Article References: Young, A. T., Turfe, A., Gershater, M., Nadir, U., Xiong, M., Zhou, L., & Mi, Q.-S. (2026). Adherence to breast cancer screening guidelines among patients with hidradenitis suppurativa: a retrospective cohort study. Archives of Dermatological Research, 318(1), Article 484. https://doi.org/10.1007/s00403-026-04930-y

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04930-y

Keywords: hidradenitis suppurativa, breast cancer screening, mammography, retrospective cohort study, dermatology, preventive care, health disparities, chronic inflammatory disease, women's health, cancer screening guidelines, Henry Ford Health, comorbidities

Unnecessary cancer screenings are not mere redundancies; they pose tangible risks to patients. Overdiagnosis, which refers to the identification of cancers that would not have caused harm during a patient’s lifetime, leads to psychological distress, unwarranted invasive procedures, and toxic treatments that carry their own health risks. These screenings also contribute to escalating healthcare costs and anxiety among patients, fueling a cycle of fear and overtreatment rather than evidence-based care. The new study, led by Dr. Jennifer LeLaurin from the University of Florida’s health outcomes and biomedical informatics division, explores deeply the sluggish process of discontinuing these practices despite clear guideline recommendations.

Dr. LeLaurin and her team, supported by the National Cancer Institute’s Consortium for Cancer Implementation Science, conducted an extensive data analysis of screening behaviors surrounding cervical and prostate cancers. The research meticulously examines the impact of guideline changes that recommended avoiding cervical cancer screening in women under 21 and over 65 years, as well as discouraging prostate cancer screening in men aged 70 and older. These guidelines stem from rigorous evaluations by the United States Preventive Services Task Force (USPSTF), an independent body that grades screening tests based on their net benefit or harm.

The findings reveal a striking disparity in the speed at which clinical practice adapts to new recommendations. While cervical cancer screening rates among younger women plummeted by 50% within a year following the guideline update, screening among women older than 65 experienced a lag that extended over 13 years to achieve a similar reduction. More concerning, prostate cancer screenings in men over 70 have stubbornly persisted without a 50% decline even more than a decade after the 2012 recommendations advised against routine testing in this group. This inertia reflects complex barriers rooted in both provider and patient behavior.

Several factors contribute to this entrenched continuation of outdated screening practices. Physicians often face difficulty abandoning long-standing routines, especially when reinforced by patient expectations shaped by years of public health messaging emphasizing early detection. Furthermore, the regular shifts in screening guidelines generate confusion for clinicians and patients alike, complicating conversations about risk-benefit profiles. The psychological weight of potentially missing a cancer diagnosis fuels conservative tendencies toward maintaining screenings, despite emerging evidence that some are low value or detrimental.

One segment of the research particularly underscores the technological and systemic gaps in monitoring the use of other cancer screenings, such as those for ovarian, thyroid, testicular, and pancreatic cancers. These cancers lack robust tracking mechanisms that reliably capture data on whether screening continues post-guideline changes. Consequently, the true scope of unnecessary or inappropriate testing for these cancers remains elusive. Dr. LeLaurin emphasizes the pressing need for enhanced data infrastructure to illuminate where and how low-value screenings persist, enabling targeted interventions.

The USPSTF plays a pivotal role in shaping cancer screening paradigms in the United States. This independent task force systematically reviews emerging evidence and rates screening procedures on a grading scale where a “D” signifies strong recommendations against routine use in specific populations due to lack of benefit or potential harm. Between 1996 and 2012, this task force released numerous guidelines restricting screening in asymptomatic individuals for cancers such as ovarian, thyroid, testicular, and pancreatic, in addition to refining age parameters for cervical and prostate cancer screenings. Yet, implementing these guidelines in everyday clinical practice remains a significant challenge.

Beyond clinical inertia and patient expectations, the study highlights the potential value in reexamining incentive structures within healthcare that may inadvertently encourage excessive screening. Current reimbursement models, quality metrics, and defensive medicine practices can contribute to overtesting. According to Dr. LeLaurin, meaningful progress requires not only improving education for both providers and patients but also considering policy-level changes that disincentivize the continuation of low-value and potentially harmful cancer screenings.

These findings hold broad implications for the future of cancer care and public health strategies. They emphasize that simply issuing guidelines is insufficient to alter entrenched clinical practices swiftly. Successful de-implementation of outdated screenings demands multifaceted approaches, including systems for real-time monitoring of screening practices, streamlined educational initiatives, and thoughtful communication strategies that engage patients in understanding the nuanced benefits and risks of cancer screening.

The research also adds to the ongoing debate about precision medicine and risk stratification, highlighting the need to tailor screening recommendations to individual risk profiles rather than relying on broad age-based cutoffs alone. Integrating advanced informatics tools and leveraging big data may offer solutions for dynamically adjusting screening practices and accelerating the adoption of evidence-based recommendations. However, overcoming deeply rooted cultural perceptions about cancer detection remains a formidable hurdle.

Ultimately, this narrative review shines a spotlight on the complexity of altering healthcare behaviors in the realm of cancer screening. The extended timeline required to fully de-implement non-beneficial screenings demonstrates that evidence-based medicine must contend with human factors, institutional inertia, and systemic challenges. With breast cancer screening debates and other cancer prevention efforts continuing to evolve, the message from Dr. LeLaurin and her colleagues is clear: reducing harm and promoting patient-centered care in oncology demands patience, innovation, and unwavering commitment to translating science into practice.

Subject of Research: People
Article Title: Time to de-implementation of low-value cancer screening practices: a narrative review
News Publication Date: 20-May-2025
Web References: 10.1136/bmjqs-2025-018558
References: BMJ Quality & Safety, 2025, DOI: 10.1136/bmjqs-2025-018558
Keywords: Cancer screening, Oncology, Cancer risk, Cancer patients, Prostate cancer, Cervical cancer, Ovarian cancer, Thyroid cancer, Pancreatic cancer, Testicles