USPSTF mammo recommendations: Tempest in a teapot?

The U.S. Preventive Task Services (USPSTF) recommendations that women ages 50-74 years undergo biennial screening mammography and women ages 40-49 years make an individual decision regarding screening had little impact on screening mammography use, according to a study published online May 15 in Journal of General Internal Medicine.

Few studies have examined the impact of USPSTF screening mammography recommendations, thus Lauren D. Block, MD, MPH, from the department of medicine at Johns Hopkins University School of Medicine in Baltimore, and colleagues devised a study to investigate whether mammography use declined among women ages 40-49 after USPSTF recommended women in that age group make personal screening decisions.

The researchers mined data from the Behavioral Risk Factor Surveillance Study, a national registry, to examine mammography rates among women ages 40-49 years and 50-74 years in 2006, 2008 and 2010. In addition to examining mammography use, Block et al studied access to healthcare, highest level of education obtained, race and ethnicity and health status.

The survey data included 484,296 women ages 40-74 years in 2006, 2008 and 2010. A total of 36 percent of women were 40-49 years and 64 percent were 50-74 years.

“Rates of mammogram use in the past year among women ages 40-49 and 50-74 were 51.8 percent and 64.3 percent in 2006, respectively, 53.2 percent and 65.2 percent in 2008, and 51.7 percent and 62.4 percent in 2010,” reported the researchers. These data show no significant reduction in mammogram use in younger women relative to older women.

However, Block et al observed lower rates of mammogram use among women who reported no checkup in the previous year, compared to those who had a checkup.

“Patients—and likely their providers—appear hesitant to change their behavior, even in light of evidence that routine screening in younger women carries substantial risk of false positives and unnecessary further imaging and biopsies,” Block said in a release. “Women have been bombarded with the message ‘mammograms save lives,’ so they want them no matter what.”

The researchers also suggested that the actual impact of the USPSTF recommendations on practice may not yet be evident. “One determining factor may be whether health plans continue to cover the test for women in their 40s.”

Block and colleagues called for additional follow-up on the impact of the USPSTF recommendations on screening mammography use and breast cancer-associated morbidity and mortality.