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New advice didn't change breast screening rates

By Andrew M. Seaman

NEW YORK (Reuters Health) - Women in their 40s didn't cut back on mammograms during 2010, the year after a government-backed panel said annual breast cancer screening should be optional for them, says a new study.

Researchers found that the odds of U.S. women between the ages of 40 and 49 getting a mammogram remained stable from 2006 to 2010. So did mammography rates among women in their 40s relative to those of older women, who were still advised to get regular breast cancer screenings.

"That signals to us that (the women) or providers may be hesitant to change their behaviors based on recommendations," said Dr. Lauren Block, the study's lead author from the Johns Hopkins University School of Medicine in Baltimore.

The U.S. Preventive Services Task Force (USPSTF), a government-backed panel of preventive medicine experts, made headlines in December 2009 when it changed its recommendation on who should get mammograms to screen for breast cancer.

Instead of advising women 40 and older to get screened every one or two years, as many other health advocates do, the panel said the decision to get a mammogram should be an individual one for women younger than 50 years old with an average risk for breast cancer.

For women between the ages of 50 and 74 years old, the panel recommended getting a mammogram every two years.

The USPSTF based its decision on an analysis of previous studies that found screening women in their 40s for breast cancer reduced deaths. But it also returned many "false positives," which often lead to anxiety and to further painful and expensive invasive testing and procedures that carry their own set of risks.

"We don't say don't do this. What we say is because the benefits are small and the harms are real, no woman should be ordered to get one. She should have a say," said Dr. Virginia Moyer, who chairs the USPSTF but was not involved in the new study.

For the new analysis, which was published in the Journal of General Internal Medicine, the researchers used data from an annual national health survey that asks women between the ages of 40 and 74 years old if they had a mammogram during the past year.

Taking data from the 2006, 2008 and 2010 surveys, the team had information on almost 500,000 women.

Overall, Block and her colleagues found that women younger than 50 years old were less likely to have a mammogram in any of the three years examined than were women over 50.

And women who got annual checkups were slightly more likely to get mammograms.

Among women who got checkups and were in their 40s, around 62 percent had mammograms in 2006 and 2008, and 61 percent did in 2010.

Among older women who got checkups, 70 percent to 73 percent got mammograms too in each of the three years studied.

"It's not a big surprise that this hasn't changed overnight, and I think what's likely to happen is it will change gradually," said Moyer, who is also the Vice President for Maintenance of Certification and Quality at the American Board of Pediatrics in Chapel Hill, North Carolina.

One limitation of the study is that the national data are culled from state surveys, which take place at various times during the year. So women asked early in 2010 whether they'd had a mammogram in the past year would not necessarily have had their decision influenced by the late-2009 announcement of the new USPSTF recommendation.

Block told Reuters Health that the large number of women included in her study compensates for that weakness. Plus, other research has shown results similar to hers (see Reuters Health article of April 25, 2013 here: http://reut.rs/13LWcob.)

Both Moyer and Block said doctors may see more of a shift in women's behavior if and when other organizations start changing their advice to be more in line with the USPSTF.

"Nothing changes overnight. Even given a recommendation that is clear based on good evidence, it's really hard for people to change what they do and what they believe," Moyer said.

SOURCE: http://bit.ly/11YJRzj Journal of General Internal Medicine, online May 15, 2013.

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