Screening mammography rates decline in Vt. following USPSTF recommendations

The percentage of women who underwent breast cancer screening mammography in Vermont declined from 45.3 percent in 2009 to 41.6 percent in 2011, a decrease that coincides with the 2009 revision of the U.S. Preventive Services Task Force (USPSTF) recommendations for screening, according to a study published online Sept. 26 in Radiology.

These guidelines established by the USPSTF pertain to the general population and are not expected to influence screening mammography among women with personal histories of breast cancer, wrote Brian L. Sprague, PhD, of the University of Vermont, Burlington, and colleagues.

Changes in the guidelines included a reversal on the need for routine breast cancer mammography screening in women ages 40-49. Rather, the USPSTF stated that the decision to undergo screening in this patient population should be an individual choice based on the patient’s values regarding the specific benefits and harms associated with examination. Additionally, women 50-74 years old were advised to switch from annual to biennial screening. These alterations created much controversy in both scientific and public media despite limited evidence of actual changes in screening mammography utilization after the guideline revisions. Sprague and colleagues therefore aimed to determine if the 2009 USPSTF guidelines for breast cancer mammography screening were followed by changes in screening utilization in Vermont.

The retrospective study examined trends in screening mammography utilization from 1997-2011 among approximately 150,000 female residents of Vermont who were 40 years or older. Researchers employed data from the Vermont Breast Cancer Surveillance System, which collects mammography information from all breast imaging facilities within the state. Participants in the study completed demographic and health history questionnaires during their mammography visits. Radiologists and mammography technologists then provided information regarding mammography through standardized paper forms or electronic files.

Findings showed a decline in screening that aligned with the 2009 USPSTF recommendations, with an overall 8.2 percent relative decline in the population of women 40 and older undergoing screening mammography within the previous year. Reduction in annual mammography utilization was seen across all age groups of participants. Importantly, the decline in rate of annual mammography screenings after 2009 in women ages 50-74 was not counterbalanced by an increase in biennial screening by 2011. However, these particular results should be interpreted with caution, noted the researchers, as they were unable to ascertain data through a full 30-month period, which constituted the upper limit of their biennial screening definition, after the release of the 2009 USPSTF guidelines.

The study’s findings are not necessarily indicative of trends in screening utilization in other regions of the country and additional research must be conducted in order to interpret how geographic, sociodemographic, and medical system characteristics also influenced the rate of mammography utilization during this time period.

“Continued monitoring of screening utilization in future years and other populations will be needed to confirm our findings and to assess the potential effect of these changes in screening utilization on breast cancer outcomes,” wrote Sprague and colleagues.