Mammography rates stay steady after guidance
More than three years after new guidelines rejected routine annual mammograms for most women, women in all age groups continue to get yearly screenings, new research indicates.1
In 2009, the United States Preventive Services Task Force (USPSTF) recommended against routine mammogram screening for women between ages 40 and 49.2 (To review the guidance, see the Contraceptive Technology Update article, “Check the new screening guidance for cervical cancer and breast cancer,” January 2010, p. 1.)
In a study conducted by Boston-based Brigham and Women’s Hospital researchers, data indicates that mammogram rates in the United States have not declined in the 40-49 age group, or any other age group. “If the USPSTF recommendations had been widely adopted, we would have expected to see a significant decline in mammography rates among women in their 40s,” said the study’s lead author, Lydia Pace, MD, MPH, a global women’s health fellow in the hospital’s Division of Women’s Health. “However, this study demonstrates that younger women are continuing to get mammograms.”
To perform the study, researchers examined data from nearly 28,000 women who were asked about their mammography use during the 2005, 2008, and 2011 National Health Interview Survey, which has monitored the health of the nation since 1957. Their analysis indicates that among all women, mammography rates rose at a slight but statistically non-significant rate between 2008 and 2011 from 51.9% to 53.6%. Among women ages 40-49, mammography rates also rose at a slight but statistically non-significant rate between 2008 and 2011 from 46.1% to 47.5%.
The current research does not explain the reasons why mammography rates did not decline. It is worth noting, however, that several prominent professional and advocacy organizations continue to recommend mammography screening for women between the ages of 40 and 49, said Pace in a statement accompanying the paper’s publication. “Providers may disagree with the USPSTF recommendations or they may not have the time or the tools needed for discussions with patients about the relative benefits and harms of mammography,” observed Pace. “Patients may also disagree with the recommendations and may still be requesting annual mammograms or self-referring to mammography facilities.”
ACOG guidance differs
In 2011, the American College of Obstetricians and Gynecologists (ACOG) issued new breast cancer screening guidelines that recommend mammography screening be offered annually to women beginning at age 40.3 (CTU reported on the move; see “New guidance issued for breast screening,” October 2011, p. 116.)
What led to ACOG’s change for clinical practice? Three factors came into play:
• the incidence of breast cancer;
• the sojourn time for breast cancer growth;
• the potential to reduce the number of deaths from it.
The period between when a breast cancer might be detected by a mammogram while it is very small and before it grows big enough to become symptomatic is known as sojourn time. While the sojourn time of individual cancers can vary, the greatest predictor is age, the practice bulletin notes. Women ages 40-49 have the shortest average sojourn time (2-2.4 years), while women ages 70-74 have the longest average sojourn time (4-4.1 years).4
The five-year survival rate is 98% for women whose breast cancer tumors are discovered at their earliest stage, before they are palpable and when they are small and confined to the breast.
The largest and longest running breast cancer screening studies in history re-confirm that regular mammography screening cut breast cancer deaths by roughly one-third in all women ages 40 and over, including women ages 40-49,5,6, says a statement from the American College of Radiology and Society of Breast Imaging.7 “These data directly refute the USPSTF claim that mammography reduced deaths by 15% and show that the USPSTF calculations were understated by half,” the statement reads. “Doing so resulted in a doubling of the USPSTF estimate of the number of women needed to be invited to screen in order to save one life.”
References
1. Pace LE, He Y, Keating NL. Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer 2013. Doi: 10.1002/cncr.28105.
2. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009; 151:716-726.
3. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Breast cancer screening. Practice Bulletin no. 122. Obstet Gynecol 2011; 118 (2 Pt. 1): 372-382.
4. Smith RA, Duffy SW, Gabe R, et al. The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am 2004; 42:793-806.
5. Hellquist B., Duffy SW, Abdsaleh S, et al. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years. Cancer 2011; 117:714-722.
6. Tabár L, Vitak B, Chen TH, et al. Swedish two-county trial: impact of mammographic screening on breast cancer mortality during three decades. Radiology 2011; 260(3):658-663.
7. American College of Radiology and Society of Breast Imaging. ACR, SBI statement on cancer article documenting that mammography screening rates have not gone down since USPSTF recommendations. Press statement. Accessed at http://bit.ly/10W67lu.
More than three years after new guidelines rejected routine annual mammograms for most women, women in all age groups continue to get yearly screenings, new research indicates.1You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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