USPSTF screening mammo recommendations flop

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The U.S. Preventive Services Task Force (USPSTF) screening mammography recommendations revised in 2009 have not been adopted and screening mammography rates have nudged up since 2005, according to a study published April 19 in CANCER.

When the USPSTF issued its screening mammography update in 2009 and recommended against routine screening for women ages 40 to 49 years and advised biennial screening for women ages 50 to 74 years, physicians and advocates responded swiftly and decried the change, expressing concerns that the change would increase breast cancer mortality. Most payers continue to cover screening mammography.

However, researchers have not yet determined the recommendations’ impact on screening. Lydia E. Pace, MD, MPH, from the division of women’s health at Brigham and Women’s Hospital in Boston, and colleagues sought to assess their impact on screening mammography practice.

Pace and colleagues leveraged the National Health Interview Survey to assess self-reported screening mammography utilization among 27,289 women ages 40 and older who responded to the surveys in 2005, 2008 or 2011.

In addition to analyzing year and age, the researchers also reviewed self-reported race/ethnicity, immigration status, educational status, family income and insurance. More than half of respondents were in the 50 to 74 years age group, approximately 30 percent were black or Hispanic and nearly 25 percent were college graduates.

Mammography rates swelled from 49.9 percent in 2005 to 52 percent in 2008 and 54 percent in 2009. The researchers did not detect any significant decreases by subgroup of women from 2008 to 2011.

“These data suggest that neither of [the USPSTF] recommendations has been widely adopted,” wrote Pace et al.

The researchers offered several possible reasons for their findings, including a delay in guideline adherence, provider disagreement with the recommendations and patient demand for screening mammography.

They noted the ongoing concerns about overdiagnosis and overtreatment before confirming their findings. “Whether through their impact on patients, providers, or both, it seems that the vigorous policy debates and coverage in the media and medical literature have limited adoption of these recommendations.” Pace and colleagues called for continued research into the clinical and cost effectiveness of screening mammography as well as its general benefits and harms.