Mammogram numbers steady despite advice to cut frequency

Despite controversial recommendations by a government-backed task force in 2009 to reduce the rate of mammograms, the numbers of women getting them regularly have not changed significantly, according to a study in the April 19 issue of Cancer.

The U.S. Preventive Services Task Force, appointed to advise doctors, insurance companies and policymakers, recommended screening every two years for women 50 to 74 years old. For women younger than 50, the task force advised physicians and patients to decide together case by case whether to get screened. The guidelines were a departure from the panel's 2002 recommendation that women 40 and older should have the screening every one to two years.

However, years after the 2009 recommendation, numbers have not dropped, according to researchers at Brigham and Women's Hospital in Boston. They studied responses from more than 28,000 women who answered National Health Interview Survey questions in 2005, 2008 and 2011 about mammogram frequency. They found that among women 40 to 49, rates of women who had a mammogram in the past 12 months rose slightly, from 46.1% in 2008 to 47.5% in 2011. For women ages 50 to 74, the rates also inched up, from 57.2% in 2008 to 59.1% in 2011.

Although the study didn't examine the reasons for getting regular mammograms, lead author Lydia Pace, MD, MPH, global women's health fellow at Brigham and Women's, speculated that several factors may account for the virtually unchanged numbers. Likely reasons, she said, are confusion by physicians and patients over the task force's recommendations; decisions by some organizations, including the American Cancer Society, to stick with the previous recommendations; and insurance companies continuing coverage of annual mammograms. The American Medical Association adopted policy at its 2012 Annual Meeting stating that women older than 40 must be able to receive the procedure if they request it and insurance should cover the screening.

“It may be that providers don't have the time or don't have the tools or don't feel prepared to go through an in-depth risk/benefit discussion with patients,” Dr. Pace said.

Timing not likely an issue

Dr. Pace acknowledged that it's possible that the study came too soon after the recommendations to reflect change, but she said a few factors make that unlikely. One is that rates for prostate-specific antigen screening dropped significantly within a year after USPSTF recommended against the test for older men. The other is that the news of the task force's recommendations was widely known, so it's unlikely patients and doctors were slow to hear about them.

Michael LeFevre, MD, MSPH, co-vice chair of the task force, said it was “not a huge surprise that mammography did not decline.”

He said he suspects that physicians continue to recommend, rather than discuss, mammography, and added that given the controversy that followed the recommendations and the pushback from some physician organizations, some may just consider it easier to recommend the procedure routinely.

Dr. LeFevre acknowledges that the original language in the recommendations was confusing and led to many misunderstandings, a fault the panel hopes to correct in the next review with better communication and transparency. “We owe it to the public to do a good job of communicating what the science says,” he said.

The task force revisits recommendations roughly every five years, Dr. LeFevre said, adding that mammography is on track to be reviewed again in 2014.