The mammography screening rate declined among women with a history of breast cancer after the U.S. Preventive Services Task Force (USPSTF) changed its breast screening guidelines for average-risk women in 2009. The decline seems to be an unintended consequence of the guideline change, according to a research letter published August 22 in JAMA Surgery.
In 2009, the USPSTF changed its recommendation to advise that women at average risk of breast cancer start biennial mammography screening at the age of 50. The change did not address the surveillance of women with a history of breast cancer, yet it has had a dampening effect on this population's screening use as well, wrote a team led by Dr. Jessica Bensenhaver of Henry Ford Health System in Detroit.
"The optimal age for initiation of screening among U.S. women of average risk for breast cancer is controversial," the group wrote. "Personal breast cancer history is a well-documented risk factor for developing a new breast tumor. ... An annual screening mammogram is therefore incorporated into breast cancer survivorship plans unless the patient has undergone a bilateral mastectomy."
Bensenhaver and colleagues investigated the use of screening mammography among women ages 40 to 49 relative to the USPSTF 2009 guidelines and categorized by history of breast cancer. The group used data from Blue Cross/Blue Shield of Michigan between January 2008 and December 2013 for 461,125 women.
The use of mammography screening decreased after the 2009 USPSTF guidelines in women with a history of breast cancer and in those without, the investigators found.
| Percentage of women undergoing mammography screening | |||
| 2008-2009 | 2010-2011 | 2012-2013 | |
| Women with no breast cancer history | 62.5% | 59.1% | 59.8% |
| Women with history of breast cancer | 80.8% | 77.1% | 72.5% |
The study results show that the USPSTF's recommendations had the intended effect of reducing the use of mammography screening among young women. But this reduction was to the detriment of women who need to be screened because of their breast cancer history, the group concluded.
"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," they wrote. "These patients require imaging for early detection of local recurrence and/or new primary breast cancer."
