Why Are Mammography Rates Down?

A study confirms that mammography [x-rays of the breast] rates for insured women are down by 6% to 17% among white, Hispanic, and Asian women, while black women had a smaller decline.  

The study, led by J. Frank Wharam, MB, MBA, from the Harvard Pilgrim Health Care Institute, Boston, and funded by a grant from the American Cancer Society, reported on mammography rates 3 years after the 2009 United States Preventive Services Task Force announced changes in guidelines for routine mammography screenings.

The research team studied the mammography rates of 5.5 million women 40-64 years of age enrolled in a national health insurer program during 2005 to 2012.

Study findings are published online in the Journal of Clinical Oncology.

The downturn in rates occurred in the three years immediately following a controversial report in 2009 when the United States Preventive Services Task Force (USPSTF) changed its mammography scheduling recommendations to personalized screening decisions for women age 40 to 49 years and screenings every 2 years for women age 50 to 74 years. The USPSTF has since amended this report, making screening for women under 50 a matter of personal choice to be discussed with their physicians. The American Cancer Society reports on this recent development on their site.

When considering these recommendations, remember the USPSTF recommendations are independent of the U.S.government; and not the official position of U.S government agencies.

Prior to the USPSTF report, scheduling  was 1-2 years for women 40-49 years and annually for women over 50.This remains the recommended schedule of most breast cancer research, treatment and supportive services providers who regularly see women in their early 50's presenting for care with later stage cancers.

Many of the women had not begun mammogram screening in their 40's.

Unfortunately, many women don’t need any encouragement to postpone getting a mammogram. No one wants to get an x-ray that could possibly show a cancer. Women have heard or know from personal experience that a mammogram can be an uncomfortable physical experience as well as anxiety producing.They are all willing to rationalize about postponing having one. What every woman needs to know is a mammogram can pick up a cancer before it is large enough to be felt by a medical professional in a comprehensive breast exam.

In 1999 and again in 2009 my annual mammograms showed something suspicious for breast cancer. Neither of my two primary invasive breast cancers could be felt in comprehensive breast exams done immediately before my mammograms. Each was an early cancer with no spread beyond the breast. I didn’t need chemotherapy for either cancer.

When you don't need chemotherapy as a part of your treatment, you avoid a number of side effects that can be debilitating.

It is physically difficult for most women and men to work or maintain an active schedule during the months it takes them to complete their course of treatment. Chemotherapy often results in temporary hair loss. Chemotherapy affects the immune system and puts those in treatment at increased risk of infection.

Breast cancer advocacy groups are concerned for those women in their 40s, who now believe they can postpone having mammograms until they are 50 years old. Breast cancer tends to be more aggressive in younger women, who have not, as yet, gone through menopause.

Since the USPSTF report, several studies have documented the benefits of mammograms for women between the ages of 40-49 years. One study, by Judith Malmgren an affiliated professor of epidemiology at the University of Washington School of Public Health and Community Medicine reported that “Women diagnosed by mammography in their 40s have an earlier diagnosis, earlier stage, better prognosis.”

Once 50, according to the 2009 report, a woman only needs a mammogram every two years.Yet, the largest group of newly diagnosed cases of breast cancer, annually, occur in women in between 55-64 years of age.

Since 1969, when mammography came into wide-spread use, it has been an uphill climb convincing women to get annual mammograms. Over the years, we’ve witnessed breast cancers caught earlier through mammography.

Yes, there is a small percentage of missed cancers and false positives. However, the National Cancer Institute states that getting a high-quality screening mammogram and having a clinical breast exam, regularly, are the most effective ways of detecting breast cancer early. Most mammography centers in the U.S. now use digital mammography which has a proven track record of success in picking up small, early stage breast cancers.

What every woman needs to keep in mind when deciding when to start having a mammography, and how often to have one, is that early detection and intervention saves lives; it finds a cancer early and can spare a woman the extensive treatment necessary for treating a later stage cancer.

Source: Mammography Rates 3 Years After the 2009 US Preventive Services Task Force Guidelines Changes J. Frank Wharam, MB, BCh, BAO, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Ave, 6th Floor, Boston, MA 02114; e-mail: jwharam@post.harvard.edu.

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