Mammography Use and Physician Recommendation After the 2009 U.S. Preventive Services Task Force Breast Cancer Screening Recommendations

Abstract

In 2009, the U.S. Preventive Services Task Force (USPSTF) no longer recommended routine mammography for women aged 40-49 and ≥75 years (younger and older women, respectively). Whether mammography usage and physician recommendation among younger and older women changed in response to these recommendations is unclear. Cross-sectional data from women aged ≥40 years in the 2008 and 2013 National Health Interview Surveys were used (n=4,942 younger and 3,047 older women) and were analyzed in 2015. Changes between 2008 and 2013 in self-reports about having undergone mammography in the past 2 years and physician recommendation for mammography were expressed as adjusted prevalence difference (PD) and 95% CI. Overall, adjusted prevalence of mammography among younger women was similar in 2008 (62.2%) and 2013 (58.5%) (p=0.05), but significantly declined in high-income (PD=-6.1%, 95% CI=-11.2, -1.0); non-Hispanic white (PD=-5.5%, 95% CI=-10.2, -0.8); and privately insured (PD=-5.7%, 95% CI=-9.8, -1.6) younger women. For older women, there was no change in adjusted mammography prevalence overall (2008, 56.2%; 2013, 54.2%; p=0.473) or by SES. Physician mammography recommendation declined in younger (PD=-5.0%, 95% CI=-8.7, -1.3) and older (PD=-5.8%, 95% CI=-10.5, -1.1) women. Four years after publication of USPSTF mammography recommendations, mammography prevalence for younger and older women did not significantly decrease except for higher-SES younger women. The significant decrease in physician recommendation of mammography in younger and older women may reflect a change in practice patterns by some physicians in response to USPSTF recommendations.