About 40% of insured women in the United States are not undergoing screening mammography at least every 2 years in keeping with guidelines from the US Preventive Services Task Force (USPSTF). Even fewer are getting annual mammograms as recommended by the American Cancer Society (ACS).
"This is cause for concern. All guidelines recommend mammography at a minimum of every 2 years in average-risk healthy women aged 50 to 74. Continued public education and access to mammography are of utmost importance to reaching target goals for breast cancer screening," said lead author Milayna Subar, MD, vice president and national practice leader for Medco Health Solutions in Franklin Lakes, New Jersey, who presented fi ndings from a retrospective study.
USPSTF guidelines, updated in 2009, recommend biennial screenings for women aged 50 to 74 years and individualized decisions on when to start regular screenings for women aged <50 years. The panel does not make recommendations for women aged >75 years. The ACS recommends healthy women undergo annual mammography screenings beginning at age 40.
"After the updated [USPSTF] guidelines were issued, there was a huge outcry, so we decided to conduct a study to determine what women are actually doing regarding mammography screening," Subar said.
Using the Medco Health Solutions database, which contains healthcare records for more than 12 million people with employerprovided insurance or Medicare, Subar and colleagues reviewed medical claims from January 2006 to December 2009 for women aged ≥40 years. They identified >1.5 million women in that age group who had no prior history of breast cancer.
Results were stratified into 4 groups: aged ≥40 years, aged 40 to 49 years, aged 50 to 64 years, and ≥65 years. They were also stratified by year (2006-2009).
In examining broad utilization rates, researchers found women aged 50 to 64 years as a group had the highest rate of adherence to annual mammography screening recommendations, with 54% receiving the test in any given year during the 4-year period. By comparison, 47% of women aged 40 to 49 years and 45% of women aged ≥65 years received an annual mammogram in any given year.
Frequency of Mammography
Number of Mammograms Over 4 Years
40 and Older
65 and Older
Source: Medco Research Institute. Compliance with mammographic screening guidelines from an administrative claims database. Medco. Medco Health Solutions Inc clinical brief. Published December 9, 2010. Accessed January 18, 2011.
On an individual level, however, the lack of utilization is more dramatic (Table
). During the 4-year period, the percentage of women undergoing at least 1 mammogram was only 21% overall, according to Medco Research Institute's clinical brief on the study. (Medco Research Institute