Mammograms down 6% after guideline change

Controversy remains about when and how often women should be screened, but experts say more research is needed to determine the impact of recommendations.

By Carolyne Krupa — Posted July 16, 2012

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The number of women in their 40s receiving mammograms dropped nearly 6% the year after the U.S. Preventive Services Task Force released its 2009 breast cancer screening guidelines, new Mayo Clinic research says.

Researchers analyzed national data from 2006-2010 on mammograms of nearly 8 million U.S. women 40 to 64 years old. They found that mammograms declined by about 54,000, or 5.7%, for women 40 to 49 in 2010, according to a report presented by Mayo on June 26 at the AcademyHealth annual research meting in Orlando, Fla.

The decrease is small but significant, said report co-author Nilay Shah, PhD, assistant professor of health services research at Mayo Clinic in Rochester, Minn.

“The 2009 USPSTF guidelines resulted in significant backlash among patients, physicians and other organizations, prompting many medical societies to release opposing guidelines,” Shah said. “We were interested in determining the impact that the recommendations and subsequent public debate had upon utilization of mammography in younger women.”

In its recommendations, the task force called for biennial mammograms for women 50 to 74. For younger women, the panel advised physicians and patients to determine on an individual basis whether they should have mammograms. The guidance was a shift from the USPSTF’s previous recommendations, which called for women in their 40s to undergo mammograms every one to two years.

USPSTF Co-Vice Chair Michael L. LeFevre, MD, MSPH, said it’s unclear from the data whether the task force’s recommendations caused the drop. Other factors may have contributed, such as tight hospital budgets and patients avoiding the cost of getting screened.

“It’s really difficult to draw any conclusions about cause and effect,” said Dr. LeFevre, professor and vice chair of family and community medicine at the University of Missouri-Columbia School of Medicine.

Several organizations, including the American Cancer Society and Mayo Clinic, have released opposing guidelines recommending annual mammograms beginning at age 40. The AMA’s House of Delegates adopted policy in June aimed at ensuring that women in their 40s have access to insurance coverage for mammograms if they want them.

The 2010 decline in screening is troubling because mammograms save lives, said Carolyn Runowicz, MD, a gynecologic oncologist and professor of obstetrics and gynecology at Florida International University Herbert Wertheim College of Medicine in Miami.

For its recommendations, the USPSTF reviewed research and projected benefits versus harms, such as unnecessary imaging tests and biopsies. Dr. Runowicz is concerned that some women are getting the wrong message from the task force and believe mammograms are harmful.

“My patients can live with a little anxiety. They cannot live with a little cancer,” she said.

Dr. LeFevre said the USPSTF’s recommendations have been misinterpreted.

“The perception still exists that the task force recommended against mammographies for women in their 40s. We did not,” he said. “We just think it should be an informed choice. It is an active decision, rather than a passive one in which doctors are telling women what they need to do.”

More research is needed to determine the impact of the task force’s recommendations, Shah said. He and his fellow researchers are analyzing 2011 data and will add that to their findings for publication.

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External links

U.S. Preventive Services Task Force recommendation for breast cancer screening, 2009 (link)

Mayo Clinic on declining rates of preventive mammography after task force recommendation (link)

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