Do Cancer Screening Guidelines Change Behavior?

Breast cancer screening mammography did not decline after revised USPSTF recommendations

(RxWiki News) Several years ago, the US Preventive Services Task Force (USPSTF) recommended that women in their 40s not have breast cancer screening mammograms.  USPSTF also said there was “insufficient evidence” for women 75 and older to be screened. Did women follow these guidelines?

A newly published study found that the 2009 USPSTF recommendations did not change breast cancer screening practices in 2010. Women in their 40s still had mammograms at the rates they did prior to the new guidance, as did older women.

Daniel B. Kopans, MD, professor of radiology at Harvard Medical School and senior radiologist at the Breast Imaging Division at Massachusetts General Hospital, told dailyRx News, “Screening began in the US in the mid 1980’s and, as expected, the death rate began to fall in 1990. Each year there are now more than 30% fewer deaths from breast cancer, predominantly due to screening.”

"Determine the best breast cancer screening program for you with your doctor."

David H. Howard, PhD, associate professor of Health Policy and Management at Emory University in Atlanta. led the study. In 2002, the USPSTF recommended that women aged 40-49 have a screening mammogram every year or every other year. In 2009, the Task Force suggested no screening for women 40-49 or 75 years and older.

The new recommendation counseled women between 50-74 to have mammograms every two years. Exceptions to these guidelines included women with a family history of breast cancer and other risk factors.

This study looked at the short-term impact of the USPSTF recommendations. Researchers used the Medical Expenditure Panel Surveys (MEPS) for 2006 to 2010 to query nearly 30,000 women about their cancer screenings before and the year after the recommendations were published

The participants were divided into age groups – 40-49; 50-74 and 75 and older. 

Here’s what the study found:

  • Rates of mammography among women 40-49 declined by 0.5 percent in 2010.
  • For women 50-74, the rates decrease by 0.07 percent.
  • Women 75 and older had 0.1 percent fewer mammograms

None of these changes were considered statistically significant.

Dr. Kopans continued, “The USPSTF guidelines were misleading in suggesting that only high risk women in their forties should be screened. The facts are that most breast cancers (75-90 percent) occur among women who have no risk factors other than that they are women. Screening based on risk will result in missing most women who develop breast cancer."

So, according to Dr. Kopans, “All women ages 40 and over should be encouraged to participate in annual screening.”

The study authors concluded, “Our analysis suggests that the 2009 revision to the USPSTF breast cancer screening recommendation did not have a short-term impact on screening patterns.

This study was published in the November issue of Preventive Medicine. Funding information was not provided and no author reported a conflict of interest.

Review Date: 
November 6, 2012