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Mammography rates 3 years after the 2009 US Preventive Services Task Force Guidelines changes.
J Frank Wharam1, Bruce Landon2, Fang Zhang2
1All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA. jwharam@post.harvard.edu.
Summary
The US Preventive Services Task Force (USPSTF) 2009 mammography guideline changes led to significant declines in screening rates for women aged 40-64. These reductions varied by race/ethnicity, with black women showing no significant changes.
Area of Science:
- Public Health
- Preventive Medicine
- Health Services Research
Background:
- The US Preventive Services Task Force (USPSTF) updated mammography screening guidelines in 2009.
- The new recommendations shifted from routine annual/biennial screening for women aged 40-74 to personalized decisions for those 40-49 and biennial screening for ages 50-74.
- This study examines the impact of these guideline changes on mammography utilization.
Purpose of the Study:
- To assess mammography screening trends following the 2009 USPSTF guideline revisions.
- To quantify changes in annual and biennial mammography rates among women aged 40-64.
- To analyze these changes stratified by age group and race/ethnicity.
Main Methods:
- Analysis of mammography utilization data from 5.5 million women aged 40-64 insured by a large national health insurer.
- Used 2005-2009 data to predict expected 2012 mammography rates.
- Compared observed 2012 rates against predicted rates to estimate changes, stratified by age and race/ethnicity.
Main Results:
- Mammography rates declined significantly post-guideline change: 9.9% for women aged 40-49 and 6.1% for women aged 50-64.
- Biennial screening reductions were observed: 9.0% for women aged 40-49 and 6.2% for women aged 50-64.
- Racial/ethnic disparities emerged: declines were less pronounced or non-existent among black women compared to white, Hispanic, and Asian women.
Conclusions:
- The 2009 USPSTF mammography guidelines were associated with a 6%-17% reduction in screening rates among white, Hispanic, and Asian women.
- Black women did not experience a significant change in mammography rates following the guideline update.
- The observed reductions in biennial mammography may be an unintended consequence of the revised USPSTF recommendations.