Abstract
BackgroundThe 2009 US Preventive Services Task Force breast cancer screening update recommended against routine screening mammography for women aged 40–49; confusion and release of conflicting guidelines followed. We examined the impact of the USPSTF update on population-level screening mammography rates in women ages 40–49.Methods and FindingsWe conducted a retrospective, interrupted time-series analysis using a nationally representative, privately-insured population from 1/1/2006-12/31/2011. Women ages 40–64 enrolled for ≥1 month were included. The primary outcome was receipt of screening mammography, identified using administrative claims-based algorithms. Time-series regression models were estimated to determine the effect of the guideline change on screening mammography rates. 5.5 million women ages 40–64 were included. A 1.8 per 1,000 women (p = 0.003) decrease in monthly screening mammography rates for 40–49 year-old women was observed two months following the guideline change; no initial effect was seen for 50–64 year-old women. However, two years following the guideline change, a slight increase in screening mammography rates above expected was observed in both age groups.ConclusionsWe detected a modest initial drop in screening mammography rates in women ages 40–49 immediately after the 2009 USPSTF guideline followed by an increase in screening rates. Unfavorable public reactions and release of conflicting statements may have tempered the initial impact. Renewal of the screening debate may have brought mammography to the forefront of women's minds, contributing to the observed increase in mammography rates two years after the guideline change. This pattern is unlikely to reflect informed choice and underscores the need for improved translation of evidence-based care and guidelines into practice.
Highlights
In November 2009, the United States Preventive Services Task Force (USPSTF) issued updated screening mammography guidelines which recommended ‘‘against routine screening mammography in women aged 40 to 49 years (C recommendation) [1],’’ marking a major change from their previous recommendation of routine screening mammography every 1 to 2 years starting at age 40
We detected a modest initial drop in screening mammography rates in women ages 40–49 immediately after the 2009 USPSTF guideline followed by an increase in screening rates
Based on the projected trend post-guideline change, we found an initial 1.8 per 1,000 (p = 0.003) enrolled women per month decrease in screening mammography rates in the 40–49 age group two months after the update (Table 1, Figure 2)
Summary
In November 2009, the United States Preventive Services Task Force (USPSTF) issued updated screening mammography guidelines which recommended ‘‘against routine screening mammography in women aged 40 to 49 years (C recommendation) [1],’’ marking a major change from their previous recommendation of routine screening mammography every 1 to 2 years starting at age 40. In December 2009, this wording was revised to ‘‘the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms [1].’’ This guideline shift triggered an intense national discussion with vociferous dissent from the public as well as physicians, and prompted many professional organizations including the American Cancer Society to reaffirm their differing positions on screening mammography [2]. The 2009 US Preventive Services Task Force breast cancer screening update recommended against routine screening mammography for women aged 40–49; confusion and release of conflicting guidelines followed. We examined the impact of the USPSTF update on population-level screening mammography rates in women ages 40–49
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