Biennial mammography rates declined after the 2009 U.S. Preventive Services Task Force guideline update, with the largest decrease among non-Hispanic Black women aged 40 to 49 years and among Hispanic women aged 75 years or older, according to a recent study.
Researchers conducted a cross-sectional study to evaluate changes in mammography screening rates following the 2009 U.S. Preventive Services Task Force (USPSTF) policy update, which recommended biennial screening only for females aged 50 to 74 years. The study, published in JAMA Network Open, utilized data from the Behavioral Risk Factor Surveillance System biennial cancer screening module from 2000 to 2018. Researchers implemented a difference-in-differences design to compare biennial mammography rates among approximately 1.6 million female respondents aged 40 to 84 years.
The study—led by Jason Semprini, PhD, MPP, of the Department of Public Health at Des Moines University College of Health Sciences, and colleagues—assessed trends in two exposed groups: females aged 40 to 49 years and those 75 years or older, relative to the unexposed control groups of females aged 50 to 64 years and 65 to 74 years, respectively. Subgroup analyses examined variations by race and ethnicity, educational attainment, income, smoking history, binge drinking status, and state of residence.
Prior to the 2009 policy update, 75% of respondents reported undergoing biennial mammography. After the update, the probability of a biennial mammogram decreased by 1.1 percentage points (95% confidence interval [CI] = −1.8% to −0.3%) in females aged 40 to 49 years. The largest decrease was observed among non-Hispanic Black women (−3.0 percentage points; 95% CI = −5.5% to −0.5%). In females aged 75 years or older, biennial mammography declined by 4.8 percentage points (95% CI = −6.3% to −3.5%). Hispanic females in this age group exhibited the largest reduction (−6.2 percentage points; 95% CI = −11.7% to −0.7%), whereas non-Hispanic Black females showed no significant change. Differences were also observed by binge drinking status, with non–binge drinkers experiencing a greater decline in mammography adherence.
State-level analyses demonstrated statistically significant declines in mammography adherence in 12 states and the District of Columbia for those aged 40 to 49 years, and in 25 states and the District of Columbia for those aged 75 years or older. Among states with significant declines, many had previously expanded Medicaid, which may have improved access to screening services but also led to changes in health-care utilization patterns. Differences in state-level implementation of USPSTF recommendations, provider reimbursement rates, and outreach efforts may have further contributed to the observed variations in screening rates.
The study findings suggest that socioeconomic and geographic factors contributed to variations in mammography adherence following the 2009 USPSTF update. Future research should assess how policy changes, including the 2024 update, influence disparities in screening behavior and risk assessment, concluded the study authors.
Full disclosures can be found in the published study.