Preventive mammograms for women in their 40s decline

Volume 1, Issue 2, 2012
Nilay D. Shah, Ph.D.

Nilay D. Shah, Ph.D.

Preventive mammography rates for women in their 40s have dropped nearly 6 percent nationwide since the U.S. Preventive Services Task Force (USPSTF) issued new guidelines that recommended against routine mammograms for women in this age group, a Mayo Clinic Cancer Center analysis shows. That represents a small but significant decrease since the controversial guidelines were released, the researchers say. Their findings were presented at the 2012 AcademyHealth Annual Research Meeting.

"The 2009 USPSTF guidelines resulted in significant backlash among patients, physicians and other organizations, prompting many medical societies to release opposing guidelines," said analysis co-author Nilay D. Shah, Ph.D., a researcher at Mayo Clinic. "We were interested in determining the impact that the recommendations and subsequent public debate had upon utilization of mammography in younger women."

Using a large, national representative database of 100 health plans, researchers identified the number of screening mammograms performed between January 2006 and December 2010 and compared rates before and after the task force report. Nearly 8 million women ages 40 to 64 were included in the analysis.

Comparing mammography rates before and after publication of the new guidelines, researchers found that the recommendations were associated with a 5.72 percent decrease in the mammography rate for women ages 40 to 49. During the course of a year, nearly 54,000 fewer mammograms were performed in this age group, the analysis showed.

"For the first year after the guidelines changed, there was a small but significant decrease in the rate of mammography for women ages 40 to 49," Dr. Shah said. "This is consistent with the context of the guidelines change. A modest effect is also in line with the public resistance to the guidelines change and the subsequent release of conflicting guidelines."

Mammography screening: What Mayo Clinic recommends

Sandhya Pruthi, M.D.

Sandhya Pruthi, M.D.

The Mayo Clinic Cancer Center continues to recommend an annual screening mammogram beginning at age 40, in line with recommendations from the American Cancer Society. Mayo Clinic uses a three-tiered approach:

  • Breast health awareness, which includes a woman becoming familiar with her breasts to identify breast abnormalities or changes and to inform her doctor of any changes that may need further evaluation
  • A clinical breast exam performed by a health care provider and recommended annually beginning at age 40
  • Screening mammography beginning at age 40

"Screening mammography is not a perfect exam, but it is the best available tool to detect cancer early," said Sandhya Pruthi, M.D., a physician and researcher at Mayo Clinic Cancer Center. "Early detection can lead to better options and possibly less aggressive treatments."

U.S. Mammograms Decline After Task Force Recommendation

Watch a video of Dr. Pruthi discussing this study.

We're definitely seeing a sense of confusion. Patients are not sure what to do. They want to have a little more concrete recommendations that they can feel comfortable following, because their doctor supports it. That's where the other controversy is. The conflicting recommendations by pretty well-know, reputable organizations in the country, and the American Cancer Society is one, that continues to recommend that women get mammograms in their 40s yearly. Another group that is also in support of those recommendations is the American College of Obstetrics and Gynecology. And on the other side, we have the U.S. Preventive Task Force that is recommending that the 40-year-old screening be a discussion that an individual has with her physician when deciding to have a mammogram, or not.

The issue of mammography still becomes: What is the best screening tool that's available, cost effective and has been shown to decrease death from breast cancer? And mammography is it. So we can't forget that this has been shown to be a very important tool for reducing the number of deaths from breast cancer because of how helpful it is when it comes to early detection.

So I feel for our patients, and I think patients need a tool, a decision aid. Something that they can have the information provided in a simple way, basically weighing the pros and cons. And that has been how Mayo has taken the approach. We're going to continue to recommend that women be offered mammograms in their 40s and annually be screened, but bring into the discussion some of the risks and benefits, so they're informed.