Women Often Shun Mammography Guidelines

SAN ANTONIO—Researchers are reporting “woefully inadequate” mammography rates in American women, even in those with healthcare coverage.

Milayna Subar, MD, National Practice Leader, Medco Oncology Therapeutic Resource Center in Franklin Lakes, New Jersey, and colleagues analyzed medical claims data obtained in more than 1.5 million women between 2006 and 2009. All of the women had health insurance through their employer or Medicare.

The results, reported at the San Antonio Breast Cancer Symposium, showed that only 50% of women between 40 and 85 years of age had a mammogram in any given year and only 60% had two or more mammograms over a 4-year period.

The average yearly mammography rates were 47% for women aged 40 to 49 years, 54% for women aged 50 to 64 years, and 45% for women 65 years of age and older.

Subar, who is a Medco vice president, noted that her study did not examine reasons for the low screening rates but suggested that inconsistent guidelines for breast cancer screening using mammography may be a factor.

Multiple organizations have issued guidelines for mammography, she said. Such organizations include the American College of Obstetricians and Gynecologists, the American Cancer Society, the National Cancer Institute, the National Comprehensive Cancer Network, and the Society of Breast Imaging/American College of Radiology.

Patient concerns regarding cost, procedure- related discomfort, and fear are also likely to contribute to noncompliance, she said.

In addition, access to breast cancer screening may interfere with compliance. Notably, the number of mammogram facilities decreased from 9400 to 8600 between 2000 and 2003. There is also an ongoing need for more specialists in breast imaging, which may be the result of a lack of adequate training programs as well as a fear of litigation, according to Subar.

She commented that the prevalence of mammography in her study was “considerably lower than expected” given the public outcry following a recommendation by the US Pre ventive Services Task Force (USPSTF) last year that women undergo their first mammographic screening at age 50 rather than 40. In fact, around 75% of women surveyed after the USPSTF recommendation was issued maintained that they intended to undergo or continue mammographic testing during their forties.

She also pointed out that her study shows that the Healthy People 2010 goal of achieving 70% compliance with the recommendation of getting a mammogram within the past 2 years for women 40 years of age or older has still not been met. “In 2005, the last time data were available, 67% of women had had mammograms within the previous 2 years; however, this information was based on self-reports,” she noted. “We found that the current annual mammography rate is only 50%.”

Finally, Subar said that the findings underscore the need for continued public education and access to mammography to reach targets for breast cancer screening.