Harvard Medical School
Department of Health Care Policy
180 Longwood Avenue
Boston, MA 02115-5899
MedicalResearch.com: What are the main findings of the study?
Dr. Keating: We examined data from the 2005, 2008 and 2011 waves of the National Health Interview Survey (NHIS) a national population-based in person survey to assess whether mammography rates changed following the Nov 2009 USPSTF recommendations. Prior to 2009 the USPSTF recommended routine screening every 1-2 years for all women older than 40 years old. In 2009, the USPSTF advised against routine mammography screening in women under 50, and recommended biennial screening for women 50-74.
We found that rates of self-reported mammography screening in the past year did not decline from 2008 to 2011, with rates in 2011 slightly higher than in 2008, although this increase was not statistically significant. When stratified by age, rates did not decline in any age group, including women 40-49, 50-74, or ≥75 years.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Keating: Prior USPSTF recommendations on other cancer screening tests have been noted to impact clinical practice immediately, so some may have expected mammography rates to decline as early as 2010 and 2011. Our findings suggest that the 2009 USPSTF recommendations have not been widely adopted by physicians or patients. These recommendations were quite controversial, particularly the recommendation against routine screening in younger women, and many experts and advocacy and professional organizations publicly expressed disagreement with them. It may be that the publicity around the recommendations prompted women and their physicians to continue with their current patterns.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Keating: Clinicians and patients can reflect on their own use of mammography to understand if their mammography practices have changed, and if not, whether this is because they disagree with the recommendations, or because it is difficult to understand the relative benefits and harms of mammography for individual patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Keating: It is becoming clearer that mammography is not as good a test as was once thought. Although mammography has benefits, increasing information about the risks, including false positive tests and overdiagnosis (diagnosis of cancers or pre-cancerous lesions that would never become clinically evident), makes it important that women understand these benefits and harms to make informed decisions about whether and how frequently they should undergo mammography. Decision tools to help women make these decisions with their physicians are greatly needed.
Pace, L. E., He, Y. and Keating, N. L. (2013), Trends in mammography screening rates after publication of the 2009 US Preventive Services Task Force recommendations. Cancer. doi: 10.1002/cncr.28105