Impact of the 2009 US Preventive Services Task Force Guidelines on Screening Mammography Rates on Women in Their 40s

Abstract

BackgroundThe 2009 US Preventive Services Task Force breast cancer screening update recommended against routine screening mammography for women aged 40–49; confusion and release of conflicting guidelines followed. We examined the impact of the USPSTF update on population-level screening mammography rates in women ages 40–49.Methods and FindingsWe conducted a retrospective, interrupted time-series analysis using a nationally representative, privately-insured population from 1/1/2006-12/31/2011. Women ages 40–64 enrolled for ≥1 month were included. The primary outcome was receipt of screening mammography, identified using administrative claims-based algorithms. Time-series regression models were estimated to determine the effect of the guideline change on screening mammography rates. 5.5 million women ages 40–64 were included. A 1.8 per 1,000 women (p = 0.003) decrease in monthly screening mammography rates for 40–49 year-old women was observed two months following the guideline change; no initial effect was seen for 50–64 year-old women. However, two years following the guideline change, a slight increase in screening mammography rates above expected was observed in both age groups.ConclusionsWe detected a modest initial drop in screening mammography rates in women ages 40–49 immediately after the 2009 USPSTF guideline followed by an increase in screening rates. Unfavorable public reactions and release of conflicting statements may have tempered the initial impact. Renewal of the screening debate may have brought mammography to the forefront of women's minds, contributing to the observed increase in mammography rates two years after the guideline change. This pattern is unlikely to reflect informed choice and underscores the need for improved translation of evidence-based care and guidelines into practice.

Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis

“…Another prior study employed an ITS analysis using private insurance claims and showed decreasing slopes for age groups 40 to 49 and 50 to 64 years old before the guideline change, and an increasing slope after the guideline for ages 40 to 49 (Wang et al, 2014). Those findings in younger patients are the opposite of what we observed in the Medicare population, and are somewhat counterintuitive given the USPSTF guideline change.…”

“…However, The Centers for Medicare and Medicaid Services (CMS) covers a Pap smear test once every 24 months for all women and once every 12 months if a woman is at high risk for cervical or vaginal cancer, or if she is of childbearing age and have had an abnormal Pap test in the past 36 months (Centers for Medicare and Medicaid Services, 2012). Pap smear testing has also been used by previous researchers in ITS studies examining mammography in the Medicare population (Salloum et al, 2014) and privately insured populations (Wang et al, 2014).…”

“…Some investigators have examined the overall screening rate using national patient perception surveys, all of which have reported nonsignificant changes in screening mammography rates for various age groups (Block, Jarlenski, Wu, & Bennett, 2013;Howard & Adams, 2012;Pace, He, & Keating, 2013). Others using administrative claims data such as Medicare, private insurance claims, or registry data have reported mixed findings (Sharpe, Levin, Parker, & Rao, 2013;Sprague et al, 2014;Wang et al, 2014). Still others have examined the rate of subsequent screening and found that, among Medicare female beneficiaries who were previously screened, the rate of subsequent screening declined after 2009, especially among Black women and those 75 and older (Jiang, Hughes, Appleton, McGinty, & Duszak, 2015).…”

Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations

“…12,13,18,20 Another possible explanation could be that the frequency changes to every other year from every year, which could make it harder for older women to remember the last screening date. On the other hand, the fact that more than 2 million women aged 65-74 (40%) did not have a screening mammogram claim in 3 years is a potential concern.…”

“…Research to date has focused on younger women (age [40][41][42][43][44][45][46][47][48][49], ethnically diverse women, cancer patients, and providers' responses to the change in guidelines; many of the previous studies were based on self-reported survey data looking retrospectively for screening information. [12][13][14][15][16][17][18][19][20] Sharpe et al used Medicare Physician/Supplier Procedure Summary files for [2005][2006][2007][2008][2009][2010] to show that the use of screening mammography decreased in 2010, but they did not examine any differences by age or by regions. 21 The decline in the use of screening mammography found in the Sharpe study could be the result of less frequent screening for younger Medicare beneficiaries or discontinuing screening for women 75 years and older.…”