Mammography utilization down among younger women—even those with a history of breast cancer

Mammography screening is down among younger women since the U.S. Preventive Services Task Force (USPSTF) updated its breast cancer screening guidelines in November 2009, according to a recent study published in JAMA Surgery. This includes women with a history of breast cancer.

The authors tracked data from women in Michigan between the ages of 40 and 49 who underwent mammography screening from Jan. 1, 2008, to Dec. 31, 2013. A total of 1.8 percent of women studied had a history of breast cancer. Use of screening mammography dropped from 62.5 percent of patients in 2008-2009 to 59.8 percent in 2012-2013.

In addition, the drop in mammography utilization was estimated to be even more significant for women with a history of breast cancer than for women without any such a history.  

“Our results are compatible with the intended USPSTF goal to reduce the use of mammography screening among young women,” wrote Jessica M. Bensenhaver, MD, MS, department of surgery at the Henry Ford Health System in Detroit, Michigan, and colleagues. “However, the reduction in the use of mammography observed among women with a history of breast cancer conflicts with annual mammography surveillance guidelines supported by the National Comprehensive Cancer Network and the American Society of Clinical Oncology. These patients require imaging for early detection of local recurrence and/or new primary breast cancer.”

The authors noted that critics of the USPSTF’s 2009 guidelines say it is confusing for patients. Is it possible that the general sense of uncertainty among women carried over to those who have had breast cancer?

“In our study, women 40 to 49 years of age with a history of breast cancer who did not have a bilateral mastectomy comprised the comparison population evaluated as being at risk for this unintended consequence,” the authors wrote. “We observed decreasing use of mammography in this patient population for whom screening is clearly indicated.”