Reduced Mammography Rates 3 Years After 2009 U.S. Preventive Services Task Force Guidelines Changes
In a study reported in the Journal of Clinical Oncology, Wharam et al found that estimated mammography rates were lower than predicted in white, Hispanic, and Asian women since the U.S. Preventive Services Task Force (USPSTF) changed its screening recommendations in November 2009. The guidelines changed the recommendation of screening from every 1 to 2 years among women aged ≥ 40 years to personalized screening decisions for women aged 40 to 49 years and screening every 2 years for women aged 50 to 74 years.
The study involved 2005 to 2012 data from 5.5 million women aged 40 to 64 years enrolled in a large national health insurer with members in all U.S. states. Data from 2005 to 2009 were used to predict 2012 rates.
Reductions in Mammography Rates
Among women aged 40 to 49 years, the estimated observed 2012 rate was 38.8% vs a predicted 2012 rate of 43.1%, representing 9.9% relative and 4.3% absolute reductions. Relative reductions were −17.4% (95% confidence interval [CI] = −20.0% to −14.8%) in Asian women, −14.2% (95% CI = −15.9% to −12.5%) in Hispanic women, and −9.4% (95% CI = −10.1% to −8.8%) in white women, with a nonsignificant reduction of −2.3% (95% CI = −6.3% to 1.8%) in black women.
Among women aged 50 to 64 years, the estimated observed vs predicted 2012 mammography rates were 47.5% vs 50.7%, representing 6.1% relative and 3.3% absolute reductions. Relative reductions were −11.4% (95% CI = −14.0% to −8.7%) in Asian women, −7.6% (95% CI = −9.2% to −5.8%) in Hispanic women, and −6.1% (95% CI = −6.5% to −5.7%) in white women, with a nonsignificant reduction of −0.9% (95% CI = −1.9% to 3.8%) in black women.
Biennial Screening Rates
Among women aged 40 to 49 years, estimated observed vs predicted biennial screening rates were 65.8% vs 71.9%, yielding 9.0% relative and 6.2% absolute reductions. Relative reductions were −10.6% in Asian women, −9.8% in white women, and −9.2% in Hispanic women, with a nonsignificant increase of 0.1% in black women. Among women aged 50 to 64 years, estimated observed vs predicted rates were 76.5% vs 81.2%, yielding 6.2% relative and 4.7% absolute reductions. Relative reductions were −7.4% in Asian women, −7.0% in white women, and −5.7% in Hispanic women, with a nonsignificant 0.4% increase in black women.
The investigators concluded: “Three years after publication of the 2009 USPSTF guidelines, mammography rates declined by 6% to 17% among white, Hispanic, and Asian women but not among black women. Small reductions in biennial mammography might be an unintended consequence of the updated guidelines.”
J. Frank Wharam, MB, BCh, BAO, MPH, of Harvard Medical School and Harvard Pilgrim Health Care Institute, is the corresponding author of the Journal of Clinical Oncology article.
The study was supported by the American Cancer Society. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
