Impact of the 2009 United States Preventive Services Task Force Recommendations for Breast Cancer Screening on Utilization of Mammography: A Longitudinal Data Analysis

Background: In 2009, The United States Preventive Services Task Force (USPSTF) recommended against routine screening mammography for women aged 40 to 49 years, and recommended biennial rather than annual mammography for women aged 50 to 74 years for women of average risk. This recommendation caused significant backlash from patient advocates and physicians. The impact of these controversial recommendations on mammography utilization among American women is unknown. Prior research combined survey data at multiple years, but did not observe the same study cohort over time.  Therefore, a causal interpretation of their analyses could not be determined.

Method: We used longitudinal data from National Health Interview Survey and Medical Expenditure Panel Survey to compare self-reported mammography screening in 2008, 2009, and 2010. We stratified women into three age groups: 40 to 49, 50 to 74, and 75 years and older. For each respondent, the outcome of interest was if the woman received mammography in the past 2 years (biennial screening); and if the woman received mammography in the past year (annual screening). We estimated logistic multivariate regression models with person-specific fixed effects to compare mammography screening in each of the three years.

Results: The sample comprises 421 women aged 40 to 49 years, 831 women aged 50 to 74 years, and 217 women aged 75 years or older in 2008 who were asked mammography utilization questions in 2008, 2009, and 2010. The median ages of these three age groups were 44.8, 60.1, and 80.5, respectively, in 2008. The majority of women were non-Hispanic White with low rates of poverty. About half of the women reported excellent/very good heath status in these three age groups. A fifth of the women age 40 to 49 years and 10% of women age 50 to 74 years old were uninsured. Few women were immigrants (17% in age 40 to 49 years, 15% in age 50 to74 years old, and 8% in age 75 years or older) and most had at least a high school diploma. The overall biennial mammography rates rose from 68.8% in 2008 to 74.3% in 2010 (p<0.01), and annual mammography rates rose from 52.6% in 2008 to 57.0% (p<0.05). Annual and biennial mammography rates were higher in 2010 than in 2008 in women aged 40 to 49 years. Annual mammography rates were unchanged in women aged 50 to 74 years. Annual and biennial mammography rates also were unchanged in women aged 75 and older. Mammography screening rates did not decrease in any age group after the 2009 issuance of guideline changes. The sensitivity analyses didn't find any significant interaction effects between any stable personal characteristics and survey year.

Conclusions: The evidence overwhelmingly shows very little response to the USPSTF guideline recommendations for women and if anything, a slight positive response to screening frequency in younger women was observed following the 2009 guideline update.