Mammography Declines After 2009 USPSTF Recommendations
There have been “small to moderate” decreases in rates of mammography screening in insured women in the United States, according to new research.
The decreases vary by ethnic group, but all began after the US Preventive Services Task Force (USPSTF) announced changes to their recommendations in November 2009.
Specifically, by 2012, mammography rates had declined by 6% to 17% in white, Hispanic, and Asian women; the decline was less dramatic in black women.
However, it is not clear whether the “highly controversial” USPSTF guidelines are the sole reason for the decline in screening, say the study authors, led by J. Frank Wharam, MB, MBA, from the Harvard Pilgrim Health Care Institute in Boston.
In 2009, the USPSTF changed its mammography advice and recommended personalized screening decisions for women 40 to 49 years of age and screening every 2 years for women 50 to 74 years of age.
Previously, the influential organization recommended that all women 40 years and older be screened routinely every 1 to 2 years.
Downswing in Screening
Dr Wharam’s team studied mammography rates from 2005 to 2012 in 5.5 million women 40 to 64 years of age enrolled in a large national health insurer.
Their study was published online February 9 in the Journal of Clinical Oncology.
The primary outcome was the estimated difference between observed and predicted rates in 2012.
In women 40 to 49 years of age, there was a 9.9% decline (95% confidence interval [CI], –10.4% to –9.3%) in the mammography rate relative to the predicted rate. (The predicted rate was based on trends from 2005 to 2009, before the USPSTF changes.)
The declines were smallest in black women (–2.3%; 95% CI, –6.3% to 1.8%) and largest in Asian women (–17.4%; 95% CI, –20.0 to –14.8).
For women 50 to 64 years of age, annual mammography rates declined by 6.1% (95% CI, –6.5% to –5.7%) relative to the 2012 predicted rate.
There were also declines in biennial mammography rates.
For women 40 to 49 years, there was a 9.0% relative reduction in biennial rates (95% CI, –9.6% to –8.4%). In white, Hispanic, and Asian women, relative reductions were approximately 9% to 11%, whereas there was no detectable change in black women (0.1%; 95% CI, –4.0% to 4.3%).
For women 50 to 64 years, there was a 6.2% relative reduction (95% CI, –6.6% to –5.7%) in biennial mammography that was similar in white, Hispanic, and Asian women. Again, there was no change in black women (0.4%; 95% CI, –2.6% to 3.5%).
“Small reductions in biennial mammography might be an unintended consequence of the updated guidelines,” the authors conclude.
They also say the downswing in screening “could indicate some level of responsiveness to the USPSTF guidelines.” But they stop short of saying there is a cause and effect relation between the two events.
J Clin Oncol. Published online February 9, 2015.
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