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

Jiang, Miao; Hughes, Danny R.; Duszak, Richard

doi:10.1016/j.whi.2015.03.002

Cited by 29 publications

(10 citation statements)

References 27 publications

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“…However, our findings regarding the unclear impact of guidelines on screening rates contradict several previous reports that attribute changes in cancer screening trends to published guidelines, [46][47][48][49] although the literature is mixed [50][51][52] and the results are difficult to compare due to different study populations, procedure inclusion criteria, and data sources (billing or survey data). Several of these other studies used more granular data to examine screening rates before and after the publication of a specific guideline, which allows for more precise quantification of the guideline's impact than the descriptive analysis across multiple sites emphasized in our report.…”

Section: Discussioncontrasting

confidence: 98%

Medicare Cancer Screening in the Context of Clinical Guidelines

Maroongroge¹,

Yu²

2018

American Journal of Clinical Oncology

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Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

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Section: Discussioncontrasting

confidence: 98%

Medicare Cancer Screening in the Context of Clinical Guidelines

Maroongroge¹,

Yu²

2018

American Journal of Clinical Oncology

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“…However, studies including data after 2005 have produced conflicting results with some indicating a continued increase in mammography use while others suggest a stabilization or possible decline (Breen et al, 2011; Breen et al, 2007; Pace et al, 2013; Sprague et al, 2014). Some evidence suggests that the 2009 U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations calling for biennial screening may have contributed to a decline in mammography use among older women (Jiang et al, 2015b). Understanding multilevel characteristics associated with a possible decline is key to ensuring that the benefits of screening reach as many women as possible, particularly older women of screening age, given the increased risk of breast cancer in this group.…”

Section: Introductionmentioning

confidence: 99%

Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.

Hubbard

O’Meara

Henderson

et al. 2016

Preventive Medicine

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In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66–75 years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005–2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2 years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66–70 years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65–2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11–1.80) compared to women with a college degree. Women with ≥1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31–1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24–1.66). Women aged 71–75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence.

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“…[1] Evolving breast cancer screening guidelines therefore attempt to balance the potential risks of over-screening with potential benefits, especially in older women. [2–5] Where evidence is insufficient, guidelines now urge physicians to weigh their patient's “values regarding specific benefits and harms.” [6] These individualized considerations are shaped in part by complex interrelated characteristics including health and socioeconomic status (SES), access to care, race/ethnicity, health risk perceptions, and psychological traits.…”

Section: Introductionmentioning

confidence: 99%

“…[10] Health care access and insurance coverage also impact screening rates [10] independent of race/ethnicity. [5] Yet even as physicians are now required to incorporate patients’ values around screenings, there is a gap in understanding how psychological attitudes influence screening behavior.…”

Section: Introductionmentioning

confidence: 99%

Optimism may moderate screening mammogram frequency in Medicare

et al. 2019

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Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005–2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment ( p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

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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

Cited by 29 publications

References 27 publications

Medicare Cancer Screening in the Context of Clinical Guidelines

Medicare Cancer Screening in the Context of Clinical Guidelines

Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.

Optimism may moderate screening mammogram frequency in Medicare

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