Fran Lowry

November 30, 2012

CHICAGO — In 2009, the US Preventive Services Task Force (USPSTF) recommended limiting the use of screening mammography. Researchers now report that the rate of screening has declined significantly in the Medicare population.

Dr. David Levin

The rate of screening mammography declined by 4.3% in 2010, a year after the USPSTF announced the new guidelines, according to David Levin, MD, professor and chair emeritus of radiology at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, and colleagues. The results of their study were presented here at the Radiological Society of North America 98th Scientific Assembly and Annual Meeting.

From 2005 to 2009, the rate had been increasing by just less than 1% each year, Dr. Levin reported. "There is no question that that drop was the result of this task force recommendation," Dr. Levin told Medscape Medical News.

The USPSTF recommendations for screening mammography were announced on November 17, 2009. They called for women younger than 50 years to view screening as optional, women from 50 to 74 years to be screened once every 2 years, and women older than 74 years to forgo screening altogether.

Because the announcement produced tremendous controversy, it garnered widespread media attention and was very well publicized.

Dr. Levin and colleagues set out to see what results the task force recommendations had on the use of screening mammography in the female Medicare population in 2010 — the first full year after the recommendations came out.

To calculate the utilization rates per 1000 Medicare beneficiaries, they used codes for film and digital screening mammography, obtained from the Medicare Part B Physician/Supplier Procedure Summary Master Files for 2005 to 2010.

Until 2009, there was a gradual increase every year in the utilization of screening mammography. Rates per 1000 female Medicare beneficiaries were 311.6 in 2005, 312.4 in 2006, 316.2 in 2007, 320.1 in 2008, and 322.9 in 2009. This represents a compound annual growth rate of 0.9% from 2005 to 2009.

However, in 2010, the rate dropped to 309.1 — a 4.3% decline in that single year.

Is This Good or Bad?

"The introduction of these USPSTF recommendations has had a chilling effect on the willingness of women to get screened," Dr. Levin said. "There are some who would say that this is a good thing...but people who are knowledgeable about screening mammography and about breast cancer would say no, it is not a good thing. Personally, I don't think it's a good thing."

In women 40 to 49 years of age, there was a 5.7% decrease in screening mammography in 2010, according to researchers at the Mayo Clinic who analyzed data from "7.9 million women ages 40 to 64 enrolled in 100 health plans," Dr. Levin reported (J Clin Oncol. 2012;30[27 suppl]:abstract 5).

He pointed out that the American Cancer Society and the American College of Radiology continue to abide by their old recommendations, which is for women to undergo yearly screening mammography starting at age 40.

Despite this, the widespread publicity the USPSTF recommendations received could have persuaded women to forgo yearly screening for a number of reasons, he explained. "There's anxiety involved with it and there's pain."

Dr. Stamatia Destounis

Stamatia Destounis, MD, from the Elizabeth Wende Breast Care Center and the University of Rochester School of Medicine and Dentistry in New York, told Medscape Medical News that the 2009 USPSTF recommendations "have caused confusion among patients and their referring doctors."

This study "documents a significant decrease in screening numbers for women in 2010 in the Medicare population (by 4.3%), in comparison to the years prior to the USPSTF controversy. This decline may mean that women are choosing to forgo a screening study that could detect breast cancer early and be life-saving," she said.

Dr. Levin and Dr. Destounis have disclosed no relevant financial relationships.

Radiological Society of North America (RSNA) 98th Scientific Assembly and Annual Meeting: Abstract SSG02-01 Presented November 27, 2012.

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