Mammography routine in women in 40s despite USPSTF recommendations

A study of nearly 500,000 women by researchers at Johns Hopkins University shows that the U.S. Preventive Services Task Force’s (USPSTF) 2009 recommendation has done little to change women’s minds about the need for routine screening in their 40s.

The findings are from a population-based analysis of mammogram use data collected on Behavioral Risk Factor Surveillance System surveys administered in 2006, 2008, and 2010 by state health departments nationwide. Data from 484,296 women aged 40 to 74 in the 50 states and Washington, DC who were not pregnant at the time of survey were collected. In 2006 and 2008, 53.2% of women in their 40s reported having a mammogram in the past year, compared with 65.2% of women aged 50 to 74. In 2010-after the new recommendations had gone into effect-51.7% of younger women and 62.4% of older women reported having a mammogram.

In 2009, the USPSTF reviewed the evidence for use of routine screening mammography in average-risk women aged 40 to 49 years. The panel recommended that women aged 50 to 74 continue to undergo screening mammography every 2 years. For women aged 40 to 49 without a family history of breast cancer, however, they recommended that the decision about such screening be individualized, based on a discussion with their physicians about benefits and risks. The wording of the USPSTF recommendation counseling individual decision-making by patients and physicians was a compromise meant to address concerns from political and advocacy groups about original language that was more forceful in recommending against routine screening for women in their 40s.

The lead investigator on the Johns Hopkins study, Lauren D. Block, MD, MPH, speculated that one reason for the persistently high rate of screening may be that insurance companies continue to pay for routine mammograms for women in their 40s. “Women have been bombarded with the message ‘mammograms save lives,’ so they want them no matter what,” she said. “Patients-and likely their providers-appear hesitant to change their behavior, even in light of evidence that routine screening in younger women carries substantial risk of false positives and unnecessary further imaging and biopsies.” 

Block LD, Jarlenski MP, Wu AW, Bennett WL. Mammography use among women ages 40-49 after the 2009 U.S. Preventive Services Task Force recommendation. J Gen Intern Med. 2013 May 15 [Epub ahead of print]