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Sprague BL, Nowak SA, Ahern TP, Herschorn SD, Kaufman PA, Odde C, Perry H, Sowden MM, Vacek PM, Weaver DL. Long-term Mammography Screening Trends and Predictors of Return to Screening after the COVID-19 Pandemic: Results from a Statewide Registry. Radiol Imaging Cancer 2024; 6:e230161. [PMID: 38578209 PMCID: PMC11148837 DOI: 10.1148/rycan.230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
Purpose To evaluate long-term trends in mammography screening rates and identify sociodemographic and breast cancer risk characteristics associated with return to screening after the COVID-19 pandemic. Materials and Methods In this retrospective study, statewide screening mammography data of 222 384 female individuals aged 40 years or older (mean age, 58.8 years ± 11.7 [SD]) from the Vermont Breast Cancer Surveillance System were evaluated to generate descriptive statistics and Joinpoint models to characterize screening patterns during 2000-2022. Log-binomial regression models estimated associations of sociodemographic and risk characteristics with post-COVID-19 pandemic return to screening. Results The proportion of female individuals in Vermont aged 50-74 years with a screening mammogram obtained in the previous 2 years declined from a prepandemic level of 61.3% (95% CI: 61.1%, 61.6%) in 2019 to 56.0% (95% CI: 55.7%, 56.3%) in 2021 before rebounding to 60.7% (95% CI: 60.4%, 61.0%) in 2022. Screening adherence in 2022 remained substantially lower than that observed during the 2007-2010 apex of screening adherence (66.1%-67.0%). Joinpoint models estimated an annual percent change of -1.1% (95% CI: -1.5%, -0.8%) during 2010-2022. Among the cohort of 95 644 individuals screened during January 2018-March 2020, the probability of returning to screening during 2020-2022 varied by age (eg, risk ratio [RR] = 0.94 [95% CI: 0.93, 0.95] for age 40-44 vs age 60-64 years), race and ethnicity (RR = 0.84 [95% CI: 0.78, 0.90] for Black vs White individuals), education (RR = 0.84 [95% CI: 0.81, 0.86] for less than high school degree vs college degree), and by 5-year breast cancer risk (RR = 1.06 [95% CI: 1.04, 1.08] for very high vs average risk). Conclusion Despite a rebound to near prepandemic levels, Vermont mammography screening rates have steadily declined since 2010, with certain sociodemographic groups less likely to return to screening after the pandemic. Keywords: Mammography, Breast, Health Policy and Practice, Neoplasms-Primary, Epidemiology, Screening Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Brian L. Sprague
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sarah A. Nowak
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Thomas P. Ahern
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sally D. Herschorn
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Peter A. Kaufman
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Catherine Odde
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Hannah Perry
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Michelle M. Sowden
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Pamela M. Vacek
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Donald L. Weaver
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
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Mathieu E, Noguchi N, Li T, Barratt AL, Hersch JK, De Bock GH, Wylie EJ, Houssami N. Health benefits and harms of mammography screening in older women (75+ years)-a systematic review. Br J Cancer 2024; 130:275-296. [PMID: 38030747 PMCID: PMC10803784 DOI: 10.1038/s41416-023-02504-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There is little evidence on the balance between potential benefits and harms of mammography screening in women 75 years and older. The aim of this systematic review was to synthesise the evidence on the outcomes of mammography screening in women aged 75 years and older. METHODS A systematic review of mammography screening studies in women aged 75 years and over. RESULTS Thirty-six studies were included in this review: 27 observational studies and 9 modelling studies. Many of the included studies used no or uninformative comparison groups resulting in a potential bias towards the benefits of screening. Despite this, there was mixed evidence about the benefits and harms of continuing mammography screening beyond the age of 75 years. Some studies showed a beneficial effect on breast cancer mortality, and other studies showed no effect on mortality. Some studies showed some harms (false positive tests and recalls) being comparable to those in younger age-groups, with other studies showing increase in false positive screens and biopsies in older age-group. Although reported in fewer studies, there was consistent evidence of increased overdiagnosis in older age-groups. CONCLUSION There is limited evidence available to make a recommendation for/against continuing breast screening beyond the age of 75 years. Future studies should use more informative comparisons and should estimate overdiagnosis given potentially substantial harm in this age-group due to competing causes of death. This review was prospectively registered with PROSPERO (CRD42020203131).
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Affiliation(s)
- Erin Mathieu
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Naomi Noguchi
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Tong Li
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Alexandra L Barratt
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Wiser Healthcare, The University of Sydney, Sydney, NSW, Australia
| | - Jolyn K Hersch
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Wiser Healthcare, The University of Sydney, Sydney, NSW, Australia
| | - Geertruida H De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elizabeth J Wylie
- BreastScreen Western Australia, Women and Newborn Health Service, Perth, WA, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Wiser Healthcare, The University of Sydney, Sydney, NSW, Australia
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Nowak SA, Wilcock AD, Sprague BL. Spillover After Mammography Guideline Change: Evidence From State-Level Trends. Am J Prev Med 2023; 65:122-125. [PMID: 36822956 PMCID: PMC10293027 DOI: 10.1016/j.amepre.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Changes to which age groups are recommended for mammography may have affected screening rates for all women. This spillover effect has not previously been shown empirically in a national sample. METHODS Using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System from 2002 to 2018, authors tested whether screening trends at a national level changed after the 2009 U.S. Preventive Services Task Force guideline change. The authors also tested whether state-level screening trends for women aged 40-49 years and 75+ years were associated with screening trends for women aged 50-74 years. Analyses were conducted in March-December 2022. RESULTS In a model predicting state-level trends in screening for women aged 50-74 years, authors find positive, statistically significant associations with screening trends for women aged 40-49 years (p=0.033) and for women aged 75+ years (p<0.001). CONCLUSIONS Deimplementation is difficult and important for controlling healthcare spending and delivering high value care. However, states most successful at reducing mammography screening rates among those aged 40-49 years and 75+ years also had greater reductions in recommended screening among women aged 50-74 years. More work is needed to understand and mitigate the unintended consequences of deimplementation.
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Affiliation(s)
- Sarah A Nowak
- Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont.
| | - Andrew D Wilcock
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Brian L Sprague
- Department of Surgery, Larner College of Medicine at the University of Vermont, Burlington, Vermont
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Fahim C, Wiebe N, Nisenbaum R, Hamid JS, Ewusie JE, Tonelli M, Brauer P, Shaw E, Bell N, Stacey D, Holmes NM, Straus SE. Changes in mammography screening in Ontario and Alberta following national guideline dissemination: an interrupted time series analysis. F1000Res 2022; 10:1044. [PMID: 36544564 PMCID: PMC9745205 DOI: 10.12688/f1000research.55004.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: In November 2011, the Canadian Task Force on Preventive Health Care released guidelines for screening women at average breast cancer risk. Weak recommendations (framed using GRADE methodology) were made for screening women aged 50 to 74 years every two to three years, and for not screening women aged 40 to 49 years. Methods: We conducted an interrupted time series analysis using administrative data to examine bilateral mammography use before and after a release of a national breast screening guideline. Women aged 40 to 74 years living in Ontario or Alberta from 30th November 2008 to 30th November 2014 were included. Strata included age, region of residence, neighbourhood income quintile, immigration status, and education level. Results: In both provinces, mammography use rates were lower in the post-intervention period (527 vs. 556 and 428 vs. 465/1000 women in Ontario and Alberta, respectively). In Ontario, mammography trends decreased following guideline release to align with recommendations for women aged 40 to 74 (decrease of 2.21/1000 women, SE 0.26/1000, p<0.0001). In Alberta, mammography trends decreased for women aged 40 to 49 years (3/1000 women, SE 0.32, p<0.001) and 50 to 69 (2.9/1000 women, SE 0.79, p<0.001), but did not change for women aged 70 to 74 (0.7/1000 women, SE 1.23, p=0.553). In both provinces, trends in mammography use rates were sustained for up to three years after guideline release. Conclusions: We observed a decrease in screening for women aged 40-49. Additional research to explore whether shared decision making was used to optimize guideline-concordant screening for women aged 50-74 is needed.
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Affiliation(s)
- Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1T8, Canada,
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, M5B 1T8, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
| | - Jemila S. Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Joycelyne E. Ewusie
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, Hamilton, Ontario, L8N 4A6, Canada
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - Elizabeth Shaw
- Department of Family Medicine, McMaster University, Hamilton, Ontario, L8S 4K1, Canada
| | - Neil Bell
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, K1H 8L6, Canada
| | | | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, M5B 1T8, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
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Lowry KP, Callaway KA, Lee JM, Zhang F, Ross-Degnan D, Wharam JF, Kerlikowske K, Wernli KJ, Kurian AW, Henderson LM, Stout NK. Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016. J Natl Compr Canc Netw 2022; 20:379-386.e9. [PMID: 35390766 DOI: 10.6004/jnccn.2021.7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. METHODS We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. RESULTS Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. CONCLUSIONS Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.
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Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Katherine A Callaway
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Janie M Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J Frank Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Karla Kerlikowske
- Department of Medicine, and.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; and
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Valentine KD, Wegier P, Shaffer VA, Scherer LD. The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge. Med Decis Making 2022; 42:387-397. [PMID: 34470536 PMCID: PMC9885623 DOI: 10.1177/0272989x211039743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits. METHOD A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured. RESULTS With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions. CONCLUSIONS Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.
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Affiliation(s)
- K. D. Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Pete Wegier
- Sinai Health, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
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Martinez KA, Deshpande A, Lipold L, Rothberg MB. Change in individual physicians' screening mammography completion rates following the updated USPSTF guideline supporting shared decision making: An observational cohort study. PATIENT EDUCATION AND COUNSELING 2022; 105:166-172. [PMID: 33992485 DOI: 10.1016/j.pec.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To understand changes in physician screening practices in response to the 2009 U.S. Preventive Services Task Force recommendation supporting shared decision making (SDM) for mammography in women aged 40-49 years. METHODS We assessed screening completion rates for physicians in the Cleveland Clinic Health System pre-2009 (2006-2008) and post-2009 (2010-2015), and rates for physicians new to the system post-2009. We used mixed effects logistic regression to estimate the odds of a woman receiving screening post-2009. If physicians practiced SDM, we hypothesized their screening rates would change after 2009. To test this, we included each physician's pre-2009 screening rate as a predictor in the model. RESULTS Among 125 physicians, the screening rate increased from 40% to 45% from pre-2009 to post-2009. For physicians new to the health system post-2009 the rate was 32%. In the mixed effects model (N = 17,007), the strongest predictor of mammography receipt among patients post-2009 was their physician's pre-2009 screening rate (aOR:3.57 per 10% increase in pre-2009 rate; 95%CI:1.69-7.50). CONCLUSIONS Whether a woman received a mammogram post-2009 was highly associated with her physicians' pre-2009 screening rate, suggesting physicians are not individualizing screening decisions via SDM. PRACTICE IMPLICATIONS Physicians may need support to effectively practice SDM.
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Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid Ave, G10, Cleveland, OH 44195, USA.
| | - Abhishek Deshpande
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid Ave, G10, Cleveland, OH 44195, USA
| | - Laura Lipold
- Cleveland Clinic, Family Medicine, 26900 Cedar Rd, Beachwood, OH 44122, USA
| | - Michael B Rothberg
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid Ave, G10, Cleveland, OH 44195, USA
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Bytnar JA, Byrne C, Olsen C, Witkop C, Martin MB, Banaag A, Koehlmoos T. The Impact of Mammography Screening Guideline Changes in a Universally Insured Population. J Womens Health (Larchmt) 2021; 30:1720-1728. [PMID: 33600239 PMCID: PMC9839342 DOI: 10.1089/jwh.2020.8546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: The U.S. Preventive Services Task Force (USPSTF) modified breast cancer screening guidelines in November 2009. The impact has been studied among privately and Medicare insured populations, but not among universally insured women. Materials and Methods: This study compared the proportion of TRICARE beneficiaries aged 40-64 receiving mammograms from fiscal years 2006 to 2015 using an interrupted time series analysis to determine the impact of the 2009 USPSTF guideline changes. Stratified analyses evaluated differences by age (ages 40-49, 50-64), race, care setting, beneficiary type, and military status. Results: The proportion of women receiving mammograms increased from October 2005 through September 2009. A small, but significant decrease of 65-66 fewer women screened per 10,000 occurred in the first quarter of 2010 (October 1 to December 31) following the screening guideline update publication. The proportion screened then remained unchanged through 2015. Comparative analysis revealed no differences in impact between age groups, blacks and whites, or military dependents and active-duty/retirees. Conclusions: This study determined that the USPSTF guideline updates had a small, but immediate and lasting impact that was not different across age groups, beneficiary type, or race. No racial disparities in the proportion screened or in the impact of the guideline change were noted in our universally insured population.
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Affiliation(s)
- Julie A. Bytnar
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Address correspondence to: Julie A. Bytnar, MPH, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA
| | - Celia Byrne
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Cara Olsen
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine Witkop
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mary Beth Martin
- Department of Oncology, Georgetown University, Washington, District of Columbia, USA.,Department of Biochemistry & Molecular and Cellular Biology, Georgetown University, Washington, District of Columbia, USA
| | - Amanda Banaag
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Tracey Koehlmoos
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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9
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Sprague BL, Ahern TP, Herschorn SD, Sowden M, Weaver DL, Wood ME. Identifying key barriers to effective breast cancer control in rural settings. Prev Med 2021; 152:106741. [PMID: 34302837 PMCID: PMC8545865 DOI: 10.1016/j.ypmed.2021.106741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/01/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
Breast cancer is the most common cancer and the second most common cause of cancer mortality among women in the United States. Efforts to promote breast cancer control in rural settings face specific challenges. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers, and geographic distance from medical facilities. Women in rural areas have comparable breast cancer mortality rates compared to women in urban settings, but this is due in large part to lower incidence rates and masks a substantial rural/urban disparity in breast cancer survival among women diagnosed with breast cancer. Mammography screening utilization rates are slightly lower among rural women than their urban counterparts, with a corresponding increase in late stage breast cancer. Differences in breast cancer survival persist after controlling for stage at diagnosis, largely due to disparities in access to treatment. Travel distance to treatment centers is the most substantial barrier to improved breast cancer outcomes in rural areas. While numerous interventions have been demonstrated in controlled studies to be effective in promoting treatment access and adherence, widespread dissemination in public health and clinical practice remains lacking. Efforts to improve breast cancer control in rural areas should focus on implementation strategies for improving access to breast cancer treatments.
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Affiliation(s)
- Brian L Sprague
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Thomas P Ahern
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Sally D Herschorn
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Michelle Sowden
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Pathology, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Marie E Wood
- Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, Burlington, VT, USA; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
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10
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Bähler C, Brüngger B, Ulyte A, Schwenkglenks M, von Wyl V, Dressel H, Gruebner O, Wei W, Blozik E. Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study. BMC Public Health 2021; 21:23. [PMID: 33402140 PMCID: PMC7786957 DOI: 10.1186/s12889-020-10079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background We examined colorectal, breast, and prostate cancer screening utilization in eligible populations within three data cross-sections, and identified factors potentially modifying cancer screening utilization in Swiss adults. Methods The study is based on health insurance claims data of the Helsana Group. The Helsana Group is one of the largest health insurers in Switzerland, insuring approximately 15% of the entire Swiss population across all regions and age groups. We assessed proportions of the eligible populations receiving colonoscopy/fecal occult blood testing (FOBT), mammography, or prostate-specific antigen (PSA) testing in the years 2014, 2016, and 2018, and calculated average marginal effects of individual, temporal, regional, insurance-, supply-, and system-related variables on testing utilization using logistic regression. Results Overall, 8.3% of the eligible population received colonoscopy/FOBT in 2014, 8.9% in 2016, and 9.2% in 2018. In these years, 20.9, 21.2, and 20.4% of the eligible female population received mammography, and 30.5, 31.1, and 31.8% of the eligible male population had PSA testing. Adjusted testing utilization varied little between 2014 and 2018; there was an increasing trend of 0.8% (0.6–1.0%) for colonoscopy/FOBT and of 0.5% (0.2–0.8%) for PSA testing, while mammography use decreased by 1.5% (1.2–1.7%). Generally, testing utilization was higher in French-speaking and Italian-speaking compared to German-speaking region for all screening types. Cantonal programs for breast cancer screening were associated with an increase of 7.1% in mammography utilization. In contrast, a high density of relevant specialist physicians showed null or even negative associations with screening utilization. Conclusions Variation in cancer screening utilization was modest over time, but considerable between regions. Regional variation was highest for mammography use where recommendations are debated most controversially, and the implementation of programs differed the most. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10079-8.
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Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland. .,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Beat Brüngger
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Agne Ulyte
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich and University Hospital Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Oliver Gruebner
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.,Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Wenjia Wei
- Department of Epidemiology, Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Eva Blozik
- Department of Health Sciences, Helsana Group, Zürichstrasse 130, 8600, Dübendorf, Switzerland.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
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11
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Bytnar JA, Byrne C, Olsen C, Witkop CT, Martin MB, Banaag A, Koehlmoos T. The Impact of Mammography Screening Guideline Changes Among Women Serving in the U.S. Military. Mil Med 2020; 185:e2088-e2096. [PMID: 32803239 PMCID: PMC9891101 DOI: 10.1093/milmed/usaa176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The U.S. Preventive Services Task Force (USPSTF) modified their screening guidelines for breast cancer in November 2009. Previous studies evaluated the impact of these guideline changes among privately and Medicare insured populations. Women in the military form a unique population exposed to many social, environmental, and occupational hazards that may increase breast cancer incidence. By evaluating mammography screening rates among women in the military before and after the USPSTF guideline changes, this study evaluated the impact of the USPSTF breast cancer guideline change on screening mammography use within the military population and determined whether current guidelines were followed for this high-risk population with universal health care access. MATERIALS AND METHODS This study evaluated the impact of the 2009 guideline changes among the population of universally insured military servicewomen, comparing the proportion of active duty women aged 40 to 64 receiving mammograms from fiscal years 2006 to 2015 using an interrupted time series analysis. Stratified analyses evaluated differences by age (aged 40-49, 50-64), race, military branch, and rank. This research is considered exempt by the Uniformed Services University Institutional Review Board. RESULTS The proportion of insured military servicewomen receiving mammograms increased from October 2005 through September 2009. A significant decrease occurred in the first quarter of 2010 following the publication of the screening guideline update. From this new baseline, the proportion of women screened increased again through September 2015. Comparative analyses showed more pronounced effects both immediately and over time among the women aged 50 to 64 compared to those aged 40 to 49 years and among older enlisted women compared with their officer counterparts. The patterns were near identical in all subgroups; however, no changes in rate were evident among Air Force and black servicewomen aged 50 to 64 and Army and Navy/Marine Corps servicewomen aged 40 to 49 years. No racial disparities in screening or impact were noted. CONCLUSIONS The USPSTF guidelines had differential impacts among some subpopulations. While older women, aged 50 to 64 years, had a greater temporary reduction immediately after the guideline change, younger women aged 40 to 49 years had a longer-term reduction in screening following the guideline changes. No racial disparities in the proportion screened or in the impact of the guideline change were noted in this population with universal health coverage. The lack of Department of Defense standard breast cancer screening guidelines was evident from the different patterns of mammography utilization observed among military branches. To completely understand the impact of the updated screening guidelines, future studies must incorporate research focusing on changes in breast cancer morbidity and mortality as well as updated cost-benefit analyses.
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Affiliation(s)
- Julie A Bytnar
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799
| | - Celia Byrne
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799
| | - Cara Olsen
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799
| | - Catherine T Witkop
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799
| | - Mary Beth Martin
- Departments of Oncology and Biochemistry & Molecular and Cellular Biology, Georgetown University, E411 New Research Building, Washington, DC 20057
| | - Amanda Banaag
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 4301 Jones Bridge Road, Bethesda, MD 20814-4799
| | - Tracey Koehlmoos
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799
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12
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Sprague BL, Vacek PM, Mulrow SE, Evans MF, Trentham-Dietz A, Herschorn SD, James TA, Surachaicharn N, Keikhosravi A, Eliceiri KW, Weaver DL, Conklin MW. Collagen Organization in Relation to Ductal Carcinoma In Situ Pathology and Outcomes. Cancer Epidemiol Biomarkers Prev 2020; 30:80-88. [PMID: 33082201 DOI: 10.1158/1055-9965.epi-20-0889] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/25/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is widespread interest in discriminating indolent from aggressive ductal carcinoma in situ (DCIS). We sought to evaluate collagen organization in the DCIS tumor microenvironment in relation to pathologic characteristics and patient outcomes. METHODS We retrieved fixed tissue specimens for 90 DCIS cases within the population-based Vermont DCIS Cohort. We imaged collagen fibers within 75 μm of the tumor/stromal boundary on hematoxylin and eosin-stained slides using multiphoton microscopy with second-harmonic generation. Automated software quantified collagen fiber length, width, straightness, density, alignment, and angle to the tumor/stroma boundary. Factor analysis identified linear combinations of collagen fiber features representing composite attributes of collagen organization. RESULTS Multiple collagen features were associated with DCIS grade, necrosis pattern, or periductal fibrosis (P < 0.05). After adjusting for treatments and nuclear grade, risk of recurrence (defined as any second breast cancer diagnosis) was lower among cases with greater collagen fiber width [hazard ratio (HR), 0.57 per one standard deviation increase; 95% confidence interval (CI), 0.39-0.84] and fiber density (HR, 0.60; 95% CI, 0.42-0.85), whereas risk was elevated among DCIS cases with higher fiber straightness (HR, 1.47; 95% CI, 1.05-2.06) and distance to the nearest two fibers (HR, 1.47; 95% CI, 1.06-2.02). Fiber length, alignment, and fiber angle were not associated with recurrence (P > 0.05). Five composite factors were identified, accounting for 72.4% of the total variability among fibers; three were inversely associated with recurrence (HRs ranging from 0.60 to 0.67; P ≤ 0.01). CONCLUSIONS Multiple aspects of collagen organization around DCIS lesions are associated with recurrence risk. IMPACT Collagen organization should be considered in the development of prognostic DCIS biomarker signatures.
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Affiliation(s)
- Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, Burlington, Vermont. .,University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Pamela M Vacek
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Sophie E Mulrow
- Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Mark F Evans
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Amy Trentham-Dietz
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin.,Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sally D Herschorn
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Radiology, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Ted A James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nuntida Surachaicharn
- Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Adib Keikhosravi
- Department of Biomedical Engineering, Laboratory for Optical and Computations Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kevin W Eliceiri
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Biomedical Engineering, Laboratory for Optical and Computations Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont.,Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Matthew W Conklin
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. .,Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, Wisconsin
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13
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Omofoye TS, Parikh JR. Role of Breast Imaging Radiologists as Advocates for Screening Mammography. JOURNAL OF BREAST IMAGING 2020; 2:259-263. [PMID: 38424976 DOI: 10.1093/jbi/wbaa017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 03/02/2024]
Abstract
The objective of this article is to outline opportunities for breast imaging radiologists to advocate for screening mammography. Despite breast cancer being the second most common cancer in women and screening mammography's ability to reduce mortality from this disease, there remains suboptimal utilization in the community. The different guidelines for screening presented by respected organizations has created confusion for patients and referring clinicians and the eventual underutilization of screening mammography. As experts in the value of early detection, breast radiologists are well suited to take on the role of screening advocates. Using specific action steps and examples, we create a template for a radiologist to utilize in the promotion of screening among the breast imaging team, clinicians, administrators, and the community at large. By deliberately filling the role of screening mammography advocate, one can satisfy the mandate for radiologists to bring increased value to the health care team while contributing to community health and patient satisfaction.
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Affiliation(s)
- Toma S Omofoye
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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14
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Lowry KP, Trentham-Dietz A, Schechter CB, Alagoz O, Barlow WE, Burnside ES, Conant EF, Hampton JM, Huang H, Kerlikowske K, Lee SJ, Miglioretti DL, Sprague BL, Tosteson ANA, Yaffe MJ, Stout NK. Long-Term Outcomes and Cost-Effectiveness of Breast Cancer Screening With Digital Breast Tomosynthesis in the United States. J Natl Cancer Inst 2020; 112:582-589. [PMID: 31503283 PMCID: PMC7301096 DOI: 10.1093/jnci/djz184] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) is increasingly being used for routine breast cancer screening. We projected the long-term impact and cost-effectiveness of DBT compared to conventional digital mammography (DM) for breast cancer screening in the United States. METHODS Three Cancer Intervention and Surveillance Modeling Network breast cancer models simulated US women ages 40 years and older undergoing breast cancer screening with either DBT or DM starting in 2011 and continuing for the lifetime of the cohort. Screening performance estimates were based on observational data; in an alternative scenario, we assumed 4% higher sensitivity for DBT. Analyses used federal payer perspective; costs and utilities were discounted at 3% annually. Outcomes included breast cancer deaths, quality-adjusted life-years (QALYs), false-positive examinations, costs, and incremental cost-effectiveness ratios (ICERs). RESULTS Compared to DM, DBT screening resulted in a slight reduction in breast cancer deaths (range across models 0-0.21 per 1000 women), small increase in QALYs (1.97-3.27 per 1000 women), and a 24-28% reduction in false-positive exams (237-268 per 1000 women) relative to DM. ICERs ranged from $195 026 to $270 135 per QALY for DBT relative to DM. When assuming 4% higher DBT sensitivity, ICERs decreased to $130 533-$156 624 per QALY. ICERs were sensitive to DBT costs, decreasing to $78 731 to $168 883 and $52 918 to $118 048 when the additional cost of DBT was reduced to $36 and $26 (from baseline of $56), respectively. CONCLUSION DBT reduces false-positive exams while achieving similar or slightly improved health benefits. At current reimbursement rates, the additional costs of DBT screening are likely high relative to the benefits gained; however, DBT could be cost-effective at lower screening costs.
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Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | | | - Clyde B Schechter
- University of Wisconsin-Madison, Madison, WI; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Oguzhan Alagoz
- Carbone Cancer Center and Department of Population Health Sciences
- School of Medicine and Public Health, and Department of Industrial and Systems Engineering
| | - William E Barlow
- Cancer Research and Biostatistics, University of Washington, Seattle, WA
| | | | - Emily F Conant
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John M Hampton
- Carbone Cancer Center and Department of Population Health Sciences
| | - Hui Huang
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Sandra J Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Martin J Yaffe
- Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Canada
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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15
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Gao Y, Goldberg JE, Young TK, Babb JS, Moy L, Heller SL. Breast Cancer Screening in High-Risk Men: A 12-year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes. Radiology 2019; 293:282-291. [PMID: 31526252 DOI: 10.1148/radiol.2019190971] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Male breast cancer incidence is rising. There may be a potential role in selective screening in men at elevated risk for breast cancer, but the effectiveness of such screening remains unexplored. Purpose To evaluate patterns of male breast imaging utilization, to determine high-risk screening outcomes, and to delineate risk factors associated with cancer diagnosis. Materials and Methods This retrospective study reviewed consecutive male breast imaging examinations over a 12-year period (between 2005-2017). Examination indications, biopsy recommendations, and pathologic results were correlated with patient characteristics. Fisher exact test, Mann-Whitney test, Spearman correlation, and logistic regression were used for statistical analysis. Results A total of 1869 men (median age, 55 years; range, 18-96 years) underwent 2052 examinations yielding 2304 breast lesions and resulting in 149 (6.5%) biopsies in 133 men; 41 (27.5%) were malignant and 108 (72.5%) were benign. There were 1781 (86.8%) diagnostic and 271 (13.2%) screening examinations. All men undergoing screening had personal or family history of breast cancer and/or genetic mutations. There was a significant increase in the number of examinations in men relative to the number of examinations in women over time (Spearman correlation, r = 0.85; P < .001). Five node-negative cancers resulted from screening mammography, yielding a cancer detection rate of 18 per 1000 examinations (95% confidence interval [CI]: 7, 41), with cancers diagnosed on average after 4 person-years of screening (range, 1-10 person-years). Mammographic screening sensitivity, specificity, and positive predictive value of biopsy were 100% (95% CI: 50%, 100%), 95.0% (95% CI: 93.1%, 98%), and 50% (95% CI: 22.2%, 77.8%). Older age (P < .001), Ashkenazi descent (P < .001), genetic mutations (P = .006), personal history (P < .001), and first-degree family history (P = .03) were associated with breast cancer. Non-first-degree family history was not associated with cancer (P = .09). Conclusion There is potential benefit in screening men at high risk for developing breast cancer. Such screening may have increased over time. © RSNA, 2019.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Julia E Goldberg
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Trevor K Young
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - James S Babb
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Linda Moy
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Samantha L Heller
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
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Bonafede MM, Miller JD, Pohlman SK, Troeger KA, Sprague BL, Herschorn SD, Winer IH. Breast, Cervical, and Colorectal Cancer Screening: Patterns Among Women With Medicaid and Commercial Insurance. Am J Prev Med 2019; 57:394-402. [PMID: 31377088 PMCID: PMC7433028 DOI: 10.1016/j.amepre.2019.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients. METHODS This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests. RESULTS One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter. CONCLUSIONS Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.
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Affiliation(s)
| | | | - Scott K Pohlman
- Outcomes Research, Hologic, Inc., Marlborough, Massachusetts
| | | | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont; Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
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Farr DE, Brandt HM, Adams SA, Haynes VE, Gibson AS, Jackson DD, Rawlinson KC, Ureda JR, Hébert JR. Examining Breast Cancer Screening Behavior Among Southern Black Women After the 2009 US Preventive Services Task Force Mammography Guideline Revisions. J Community Health 2019; 45:20-29. [PMID: 31385186 DOI: 10.1007/s10900-019-00697-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Updated United States Preventive Services Task Force (USPSTF) and American Cancer Society mammography screening recommendations push for increased age of initiation and lengthened breast cancer screening intervals. These changes have implications for the reduction of breast cancer mortality in Black women. The purpose of this study was to examine breast cancer screening behavior in a cohort of Southern Black women after the release of the 2009 USPSTF recommendations. Surveys assessing cancer screening information were collected from members of Black churches between 2006 and 2013. The sample was restricted to women aged 40 to 74 years, who did not report a breast cancer diagnosis, or a recent diagnostic mammogram (n = 789). Percentages of women ever completing a mammogram (age 40-49) and annual mammography (age 50-74) in 2006-2009 and 2010-2013 were compared using chi-square statistics. Logistic regression models were fit to determine the predictors of adherence to pre-2010 screening guidelines. No significant changes in mammography rates were found for women in the 40-49 age group (X2 = 0.42, p = 0.52) nor for those in the 50-74 age group (X2 = 0.67, p = 0.41). Completing an annual clinical breast exam was a significant predictor of adherence to pre-2010 screening guidelines for both age groups (OR 19.86 and OR 33.27 respectively) and participation in education sessions (OR 4.26). Stability in mammography behavior may be a result of PCP's advice, or community activities grounded pre-2010 screening recommendations. More research is needed to understand how clinical interactions and community-based efforts shape Black women's screening knowledge and practices.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Heather M Brandt
- South Carolina Statewide Cancer Prevention and Control Program, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- South Carolina Statewide Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, College of Nursing, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Venice E Haynes
- South Carolina Statewide Cancer Prevention and Control Program, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Andrea S Gibson
- South Carolina Office of Rural Health, 107 Saluda Pointe Drive, Lexington, SC, 29072, USA
| | - Dawnyéa D Jackson
- Research Department, Rescue
- The Behavior Change Agency, 660 Pennsylvania Ave. SE, Suite 400, Washington, DC, 20003, USA
| | - Kimberly C Rawlinson
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
| | - John R Ureda
- Insights Consulting, Inc, 2728 Wilmot Avenue, Columbia, SC, 29205, USA
| | - James R Hébert
- South Carolina Statewide Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
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Zuley M. Author's Reply. J Am Coll Radiol 2019; 16:136-138. [PMID: 30717833 DOI: 10.1016/j.jacr.2018.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Margarita Zuley
- Department of Radiology, Division of Breast Imaging, University of Pittsburgh Medical Center, Magee Womens Hospital, 300 Halket St, Pittsburgh PA 15213.
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- Department of Radiology, Division of Breast Imaging, University of Pittsburgh Medical Center, Magee Womens Hospital, 300 Halket St, Pittsburgh PA 15213
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Detection Rates for Benign and Malignant Diagnoses on Breast Cancer Screening With Digital Breast Tomosynthesis in a Statewide Mammography Registry Study. AJR Am J Roentgenol 2019; 212:706-711. [PMID: 30673339 DOI: 10.2214/ajr.18.20255] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of our study was to determine whether detection rates of specific benign and malignant diagnoses differ for breast cancer screening with digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM) alone. MATERIALS AND METHODS We analyzed observational data from the Vermont Breast Cancer Surveillance System, including 86,349 DBT screening examinations and 97,378 FFDM screening examinations performed at eight radiology facilities in Vermont that adopted DBT screening during 2012-2016. We determined the most severe diagnosis made within 6 months after positive screening examinations. Multivariable-adjusted logistic regression was used to compare detection rates for specific diagnoses on DBT versus FFDM. RESULTS Compared with FFDM, DBT had a lower recall rate (adjusted odds ratio [OR], 0.81; 95% CI, 0.77-0.85) but comparable biopsy rate (OR = 1.05; 95% CI, 0.93-1.17), benign biopsy rate (OR = 1.12; 95% CI, 0.97-1.29), and cancer detection rate (OR = 0.94; 95% CI, 0.78-1.14). Among benign diagnoses, DBT and FFDM had comparable detection rates for nonproliferative lesions (OR = 1.19; 95% CI, 0.92-1.53), fibroepithelial proliferations (OR = 1.24; 95% CI, 0.85-1.81), proliferative lesions without atypia (OR = 1.13; 95% CI, 0.90-1.42), atypical lesions (OR = 0.77; 95% CI, 0.43-1.38), and lobular carcinoma in situ (LCIS) (OR = 0.92; 95% CI, 0.53-1.61). Among malignant diagnoses, DBT and FFDM had comparable detection rates for ductal carcinoma in situ (OR = 1.05; 95% CI, 0.70-1.57) and invasive breast cancer (OR = 0.92; 95% CI, 0.74-1.13), with no statistically significant differences in detection of invasive ductal carcinoma (OR = 0.83; 95% CI, 0.66-1.06), invasive lobular carcinoma (OR = 1.11; 95% CI, 0.59-2.07), or invasive mixed ductal-lobular carcinoma (OR = 1.49; 95% CI, 0.65-3.39). CONCLUSION Compared with FFDM, breast cancer screening with DBT has a lower recall rate while detecting a similar distribution of benign and malignant diagnoses.
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Breast Cancer Incidence by Stage Before and After Change in Screening Guidelines. Am J Prev Med 2019; 56:100-108. [PMID: 30573138 PMCID: PMC6312406 DOI: 10.1016/j.amepre.2018.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The U.S. Preventive Services Task Force changed breast cancer screening guidelines in November 2009 for mammograms in women aged 40-49 and 50-74 years. The aim of this study was to assess the impact of the 2009 guideline changes on breast cancer incidence by stage among women aged 40-49 and 50-74 years in the U.S. METHODS This was a cross-sectional trend analysis of the impact of 2009 guideline change on breast cancer incidence by stage, using data from the National Program for Cancer Registries and Surveillance, Epidemiology, and End Results Incidence-U.S. Cancer Statistics 2001-2014 database among women aged 40-74 years. Incidence was age adjusted to the U.S. standard population. Data were collected in 2001-2014, released in 2017, and analyzed in 2018. RESULTS Among women aged 40-49 years, the 4-year average annual incidence of breast cancer increased slightly in 2011-2014 for in situ, localized, and distant cancer, but decreased for regional cancer compared with the incidence in 2006-2009. Among women aged 50-74 years, the 4-year average annual incidence of breast cancer increased in 2011-2014 for localized and distant cancer, but decreased for in situ and regional cancer. Joinpoint analyses revealed that annual percentage changes decreased after 2009 for distant cancer among both women aged 40-49 and 50-74 years. The composition of breast cancer by stage was similar between 2006-2009 and 2011-2014 among both women aged 40-49 and 50-74 years. CONCLUSIONS Changes in breast cancer screening by the 2009 U.S. Preventive Services Task Force guidelines had little immediate adverse effects on the stage distribution of breast cancer diagnoses in the U.S. Monitoring the incidence by cancer stages over time is needed.
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Sprague BL, Vacek PM, Herschorn SD, James TA, Geller BM, Trentham-Dietz A, Stein JL, Weaver DL. Time-varying risks of second events following a DCIS diagnosis in the population-based Vermont DCIS cohort. Breast Cancer Res Treat 2018; 174:227-235. [PMID: 30448897 DOI: 10.1007/s10549-018-5048-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Long-term disease-free survival patterns following surgical, radiation, and endocrine therapy treatments for ductal carcinoma in situ (DCIS) are not well characterized in general US practice. METHODS We identified 1252 women diagnosed with DCIS in Vermont during 1994-2012 using data from the Vermont Breast Cancer Surveillance System, a statewide registry of breast imaging and pathology records. Poisson regression and Cox regression with time-varying hazards were used to evaluate disease-free survival among self-selected treatment groups. RESULTS With 7.8 years median follow-up, 192 cases experienced a second breast cancer diagnosis. For women treated with breast-conserving surgery (BCS) alone, the annual rate of second events decreased from 3.1% (95% CI 2.2-4.2%) during follow-up years 1-5 to 1.7% (95% CI 0.7-3.5%) after 10 years. In contrast, the annual rate of second events among women treated with BCS plus adjuvant radiation therapy increased from 1.8% (95% CI 1.1-2.6%) during years 1-5 to 2.8% (95% CI 1.6-4.7%) after 10 years (P < 0.05 for difference in trend compared to BCS alone). Annual rates of second events also increased over time among women treated with BCS plus adjuvant radiation and endocrine therapy (P = 0.01 for difference in trend compared to BCS alone). The rate of contralateral events increased after 10 years for all groups with adjuvant treatments. The rate of second events did not vary over time among women who underwent ipsilateral mastectomy (P = 0.62). CONCLUSIONS Long-term risk of a second event after DCIS varies over time in a manner dependent on initial treatment.
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Affiliation(s)
- Brian L Sprague
- Department of Surgery, University of Vermont, 1 S. Prospect St, UHC Room 4425, Burlington, VT, 05401, USA. .,Department of Radiology, University of Vermont, Burlington, VT, USA. .,University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.
| | - Pamela M Vacek
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.,Medical Biostatistics Unit, University of Vermont, Burlington, VT, USA
| | - Sally D Herschorn
- Department of Radiology, University of Vermont, Burlington, VT, USA.,University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA
| | - Ted A James
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Berta M Geller
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Janet L Stein
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.,Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA.,Department of Pathology, University of Vermont, Burlington, VT, USA
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Shaffer VA, Scherer LD. Too Much Medicine: Behavioral Science Insights on Overutilization, Overdiagnosis, and Overtreatment in Health Care. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2372732218786042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Overutilization—defined as the use of health care services for which the benefits do not outweigh the harms—has been identified as one of the leading contributors to the rising cost of health care in the United States. Although informational interventions designed to address overutilization have had a significant, but modest, impact on the rate of overutilization, they have not been sufficient to solve the problem. Also, various psychological mechanisms contribute to the desire for more medical tests and treatments. To effectively address overutilization, we need to better understand the psychological underpinnings of overuse in medicine. The article reviews recent findings from the behavioral science literature—including reliance on anecdotal evidence, test-related affect, the use of diagnostic labels, and medical maximizing tendencies—that lend insight into why patients sometimes seek, demand, or expect medical tests and treatments that are considered by experts to be low value.
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Gao Y, Albert M, Young Lin LL, Lewin AA, Babb JS, Heller SL, Moy L. What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence. Radiology 2018; 287:423-431. [DOI: 10.1148/radiol.2017171665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Marissa Albert
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Leng Leng Young Lin
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Alana A. Lewin
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - James S. Babb
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Samantha L. Heller
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Linda Moy
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
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Screening Mammography and Digital Breast Tomosynthesis: Utilization Updates. AJR Am J Roentgenol 2018; 210:1092-1096. [DOI: 10.2214/ajr.17.18767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nandam N, Gaebler-Spira D, Byrne R, Wolfman J, Reis JP, Hung CW, Todd A, Durkin J, Marciniak C. Breast cancer screening in women with cerebral palsy: Could care delivery be improved? Disabil Health J 2018; 11:435-441. [PMID: 29500093 DOI: 10.1016/j.dhjo.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with disabilities (WWD) have reported lower mammography rates than the general population, however rates for women with cerebral palsy (CP) have not been specifically studied. OBJECTIVE To evaluate mammography rates in women with CP and to identify strengths and barriers with their screening experience. METHODS Women with CP 40 years or older (n = 118) participating in a prospective cross-sectional survey were queried regarding screening status, imaging modality, and accommodation needs and availability. Categorical variables were summarized and Chi-square testing used to assess factors contributing to screening compliance. The effect of functional factors on screening was evaluated using logistic regression. RESULTS 77 women (65.3%) had mammograms within the past two years; 56 (47.5%) were screening mammograms. Severity of fine motor deficits was associated with lack of screening (OR 0.559, p = 0.019). 85 (72.0%) experienced positive staff attitudes. Facilities most often met needs for ramps, elevators, and/or wide doorways (92.9%), exam explanations (84.4%), and accessible parking (82.5%). Needs least often met included accommodations for standing (59.3%) or for difficulties with arm/shoulder positioning (57.1%), and wheelchair-accessible mammogram machines (59.1%). CONCLUSIONS The screening compliance rate for women with CP is low, although the 2-year mammography rate is comparable to that reported for WWD and the general female U.S. POPULATION Women were usually offered respectful care. Adequate physical accommodations during the procedure were reported less often than overall facility environmental accommodations. These findings demonstrate the need for improved screening rates in women with CP, and highlight areas for improving their screening experience.
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Affiliation(s)
- Neeharika Nandam
- Northwestern University Feinberg School of Medicine, 420 E. Superior St., Chicago, IL 60611, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1022, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue #86, Chicago, IL 606111, USA; Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA
| | - Rachel Byrne
- Cerebral Palsy Foundation, 3 Columbus Circle, 15th Floor, New York, NY 10019, USA; Division of Pediatric Orthopedics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, Room 800N, New York, NY 10032, USA
| | - Judith Wolfman
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 800, Chicago, IL 60611, USA; Lynn Sage Breast Center, 250 E. Superior St., Chicago, IL 60611, USA
| | - Judy Panko Reis
- Access Living, 115 West Chicago Avenue, Chicago, IL 60654, USA
| | - Chun Wai Hung
- Division of Pediatric Orthopedics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, Room 800N, New York, NY 10032, USA
| | - Allison Todd
- Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA
| | - Jordyn Durkin
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., 14th Floor, Chicago, IL 60611, USA
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1022, Chicago, IL 60611, USA; Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Ward 12-140, Chicago, IL 60611, USA.
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Stereotactic Breast Biopsy With Benign Results Does Not Negatively Affect Future Screening Adherence. J Am Coll Radiol 2018; 15:622-629. [PMID: 29433804 DOI: 10.1016/j.jacr.2017.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether false-positive stereotactic vacuum-assisted breast biopsy (SVAB) affects subsequent mammographic screening adherence. MATERIALS AND METHODS This Institutional Review Board-approved, HIPAA-compliant retrospective review of women with SVAB was performed between 2012 and 2014. Patient age, clinical history, biopsy pathology, and first postbiopsy screening mammogram were reviewed. Statistical analyses were performed using Fisher's exact, Mann-Whitney, and χ2 tests. RESULTS There were 913 SVABs performed in 2012 to 2014 for imaging detected lesions; of these, malignant or high-risk lesions or biopsies resulting in a recommendation of surgical excision were excluded, leaving 395 SVABs yielding benign pathology in 395 women. Findings were matched with a control population consisting of 45,126 women who had a BI-RADS 1 or 2 screening mammogram and did not undergo breast biopsy. In all, 191 of 395 (48.4%) women with a biopsy with benign results and 22,668 of 45,126 (50.2%) women without biopsy returned for annual follow-up >9 months and ≤18 months after the index examination (P = .479). In addition, 57 of 395 (14.4%) women with a biopsy with benign results and 3,336 of 45,126 (7.4%) women without biopsy returned for annual follow-up >18 months after the index examination (P < .001). Older women, women with personal history of breast cancer, and women with postbiopsy complication after benign SVAB were more likely to return for screening (P = .026, P = .028, and P = .026, respectively). CONCLUSION The findings in our study suggest that SVABs with benign results do not negatively impact screening mammography adherence. The previously described "harms" of false-positive mammography and biopsy may be exaggerated.
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Buist DSM, Gao H, Anderson ML, Onega T, Brandzel S, Rabelhofer MA, Bradford SC, Aiello Bowles EJ. Breast cancer screening outreach effectiveness: Mammogram-specific reminders vs. comprehensive preventive services birthday letters. Prev Med 2017; 102:49-58. [PMID: 28655547 PMCID: PMC5638650 DOI: 10.1016/j.ypmed.2017.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 12/28/2022]
Abstract
We compared the effectiveness of two outreach strategies on timely mammography adherence: a mammogram-specific reminder letter (sent just before a woman was due) to a birthday letter (addresses multiple preventive services and not timed around due dates). We evaluated screening mammography adherence following 79,848 mammogram-specific and 151,626 birthday letters mailed between 2002 and 2012 to women aged 40-74years enrolled in Kaiser Permanente Washington. Screening mammogram adherence was specifically tied to due date and was evaluated separately by age group and up-to-date or overdue status at the time of mailing. We used generalized estimating equations to account for correlation between repeated observations, to model the odds of screening mammography adherence by letter type. Among women up-to-date, adherence following birthday letters was 22-76% lower compared to the mammogram-specific reminders, with the greatest decreases in adherence in women aged 70-74. Birthday letters were more effective at activating screening uptake among some subgroups of overdue women aged 50-69 and most overdue women aged 70-74, but universally low adherence rates were observed in overdue women. Increasing number of recommended services for women aged 50-74 who were up-to-date resulted in 12-17% lower mammography adherence, but had no effect in women aged 40-49 or in overdue women. Birthday letters are less effective than mammogram-specific reminder letters at prompting women to undergo timely breast cancer screening, particularly among women up-to-date with screening. Birthday letters may be effective at increasing overall preventive care; however, supplemental outreach may be needed around the due date to increase timely preventive services receipt.
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Affiliation(s)
- Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Tracy Onega
- Geisel School of Medicine, Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA.
| | - Susan Brandzel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Health Stories Project Insights, 601 Union Street, Suite 4820, Seattle, WA 98101, USA.
| | - Melissa A Rabelhofer
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Susan Carol Bradford
- Kaiser Permanente Washington, Clinical Prevention and Improvement, 310 15th Ave E, Seattle, WA 98112, USA.
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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Haas JS, Barlow WE, Schapira MM, MacLean CD, Klabunde CN, Sprague BL, Beaber EF, Chen JS, Bitton A, Onega T, Harris K, Tosteson ANA. Primary Care Providers' Beliefs and Recommendations and Use of Screening Mammography by their Patients. J Gen Intern Med 2017; 32:449-457. [PMID: 28070772 PMCID: PMC5377895 DOI: 10.1007/s11606-016-3973-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Revised breast cancer screening guidelines have fueled debate about the effectiveness and frequency of screening mammography, encouraging discussion between women and their providers. OBJECTIVE To examine whether primary care providers' (PCPs') beliefs about the effectiveness and frequency of screening mammography are associated with utilization by their patients. DESIGN Cross-sectional survey data from PCPs (2014) from three primary care networks affiliated with the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, linked with data about their patients' mammography use (2011-2014). PARTICIPANTS PCPs (n = 209) and their female patients age 40-89 years without breast cancer (n = 30,233). MAIN MEASURES Outcomes included whether (1) women received a screening mammogram during a 2-year period; and (2) screened women had >1 mammogram during that period, reflecting annual screening. Principal independent variables were PCP beliefs about the effectiveness of mammography and their recommendations for screening frequency. KEY RESULTS Overall 65.2% of women received >1 screening mammogram. For women 40-48 years, mammography use was modestly lower for those cared for by PCPs who believed that screening was ineffective compared with those who believed it was somewhat or very effective (59.1%, 62.3%, and 64.7%; p = 0.019 after controlling for patient characteristics). Of women with PCPs who reported they did not recommend screening before age 50, 48.1% were nonetheless screened. For women age 49-74 years, the vast majority were cared for by providers who believed that screening was effective. Provider recommendations were not associated with screening frequency. For women ≥75 years, those cared for by providers who were uncertain about effectiveness had higher screening use (50.7%) than those cared for by providers who believed it was somewhat effective (42.8%). Patients of providers who did not recommend screening were less likely to be screened than were those whose providers recommended annual screening, yet 37.1% of patients whose providers recommended against screening still received screening. CONCLUSIONS PCP beliefs about mammography effectiveness and screening recommendations are only modestly associated with use, suggesting other likely influences on patient participation in mammography.
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Affiliation(s)
- Jennifer S Haas
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Marilyn M Schapira
- University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA
| | | | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Jane S Chen
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA
| | - Asaf Bitton
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA
- Harvard Medical School, Boston, MA, USA
| | - Tracy Onega
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Kimberly Harris
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA
| | - Anna N A Tosteson
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
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Meyer D. Capsule Commentary on Haas et al., Primary Care Providers' Beliefs and Recommendations and Use of Screening Mammography by their Patients. J Gen Intern Med 2017; 32:473. [PMID: 28160186 PMCID: PMC5377900 DOI: 10.1007/s11606-017-3986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Daniel Meyer
- Medical College of Wisconsin, Milwaukee, WI, USA.
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Breast Cancer Screening in Patients With Newly Diagnosed Lung and Colorectal Cancer: A Population-Based Study of Utilization. J Am Coll Radiol 2017; 14:900-910. [PMID: 28325489 DOI: 10.1016/j.jacr.2017.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess breast cancer screening utilization in Medicare beneficiaries with colorectal and lung cancer versus cancer-free controls. METHODS Female fee-for-service Medicare beneficiaries who were ≥67 years old and diagnosed with lung or colorectal cancer between 2000 and 2011 and who reported to a Surveillance, Epidemiology, and End Results (SEER) registry (case group) were followed for 2 years after their diagnoses, unless death, a diagnosis of breast cancer, or the end of 2013 came first. A similar number of cancer-free controls were individually matched to cases by age, race, registry region, and follow-up time. Screening utilization was defined as the percentage of women with ≥1 screening mammogram during follow-up. RESULTS Overall, 104,164 cases (48% colorectal, 52% lung; 30% advanced cancer) and 104,164 controls were included. Among women with lung or colorectal cancer, 22% underwent ≥1 screening mammogram versus 26% of controls (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.78-0.82). Stratified by cancer type, 28% of colorectal cancer cases versus 29% of controls (OR 0.98; 95% CI 0.95-1.01) and 17% of lung cancer cases versus 23% of controls (OR 0.63; 95% CI 0.60-0.65) received ≥1 mammogram. When stratified by stage, 8% with advanced cancer versus 18% of controls (OR 0.33; 95% CI 0.31-0.35) and 30% with early-stage cancer versus 30% of controls (OR 1; 95% CI 0.97-1.02) underwent ≥1 mammogram. CONCLUSION Screening mammography utilization rates are similar between Medicare beneficiaries with early-stage cancer versus controls. Although the majority of patients with advanced-stage cancer appropriately do not pursue screening mammography, a small number (8%) continue with screening.
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Wernli KJ, Arao RF, Hubbard RA, Sprague BL, Alford-Teaster J, Haas JS, Henderson L, Hill D, Lee CI, Tosteson ANA, Onega T. Change in Breast Cancer Screening Intervals Since the 2009 USPSTF Guideline. J Womens Health (Larchmt) 2017; 26:820-827. [PMID: 28177856 DOI: 10.1089/jwh.2016.6076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended biennial mammography for women aged 50-74 years and shared decision-making for women aged 40-49 years for breast cancer screening. We evaluated changes in mammography screening interval after the 2009 recommendations. MATERIALS AND METHODS We conducted a prospective cohort study of women aged 40-74 years who received 821,052 screening mammograms between 2006 and 2012 using data from the Breast Cancer Surveillance Consortium. We compared changes in screening intervals and stratified intervals based on whether the mammogram at the end of the interval occurred before or after the 2009 recommendation. Differences in mean interval length by woman-level characteristics were compared using linear regression. RESULTS The mean interval (in months) minimally decreased after the 2009 USPSTF recommendations. Among women aged 40-49 years, the mean interval decreased from 17.2 months to 17.1 months (difference -0.16%, 95% confidence interval [CI] -0.30 to -0.01). Similar small reductions were seen for most age groups. The largest change in interval length in the post-USPSTF period was declines among women with a first-degree family history of breast cancer (difference -0.68%, 95% CI -0.82 to -0.54) or a 5-year breast cancer risk ≥2.5% (difference -0.58%, 95% CI -0.73 to -0.44). CONCLUSIONS The 2009 USPSTF recommendation did not lengthen the average mammography interval among women routinely participating in mammography screening. Future studies should evaluate whether breast cancer screening intervals lengthen toward biennial intervals following new national 2016 breast cancer screening recommendations, particularly among women less than 50 years of age.
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Affiliation(s)
- Karen J Wernli
- 1 Group Health Research Institute , Seattle, Washington.,2 Department of Health Services, University of Washington School of Public Health , Seattle, Washington
| | - Robert F Arao
- 1 Group Health Research Institute , Seattle, Washington
| | - Rebecca A Hubbard
- 3 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Brian L Sprague
- 4 Department of Surgery, Office of Health Promotion Research, and the University of Vermont Cancer Center, University of Vermont , Burlington, Vermont
| | - Jennifer Alford-Teaster
- 5 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire.,6 Departments of Biomedical Science and Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
| | - Jennifer S Haas
- 7 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.,8 Harvard School of Public Health, Boston, Massachusetts
| | - Louise Henderson
- 9 Department of Radiology, University of North Carolina , Chapel Hill, North Carolina
| | - Deidre Hill
- 10 University of New Mexico Cancer Center and School of Medicine, Albuquerque, New Mexico
| | - Christoph I Lee
- 2 Department of Health Services, University of Washington School of Public Health , Seattle, Washington.,11 Department of Radiology, University of Washington School of Medicine , Seattle, Washington.,12 Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Anna N A Tosteson
- 6 Departments of Biomedical Science and Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire.,13 Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon , New Hampshire
| | - Tracy Onega
- 6 Departments of Biomedical Science and Epidemiology, Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
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Narayan AK, Harvey SC, Durand DJ. Impact of Medicare Shared Savings Program Accountable Care Organizations at Screening Mammography: A Retrospective Cohort Study. Radiology 2017; 282:437-448. [DOI: 10.1148/radiol.2016160554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lee JY, Malak SF, Klimberg VS, Henry-Tillman R, Kadlubar S. Change in Mammography Use Following the Revised Guidelines from the U.S. Preventive Services Task Force. Breast J 2016; 23:164-168. [PMID: 27797121 DOI: 10.1111/tbj.12703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) recommended screening mammography every 1-2 years for women 40 years and older in 2002, and changed its recommendations in 2009 to no routine screening for women between 40 and 49 years of age; and biennial screening for women between 50 and 74 years of age. This study evaluates the change in mammographic use after the issuance of the revised recommendations. Women who participated in a cross-sectional study of breast cancer risk factors from 2007 to 2013 were asked if they had received a mammogram in the preceding 2 years. All 3442 study participants who enrolled in the study after January 1, 2011 were matched by race, age, and educational level with women enrolled between 2007 and 2010. The proportions of women who stated they had received a mammogram in the past 2 years were compared between the two groups. One fourth of the participants were African American and 39% were 40-49 years of age. Among white women, significant decreases in recent mammogram use from 2007-2010 to 2011-2013 were detected for women 40-49 years of age (-10.3%, p < 0.001) and 50-74 years of age (-8.8%, p < 0.001). Among African-American women, the change in recent mammogram use was not statistically significant for women 40-49 years of age (-2.7%, p = 0.440) or 50-74 years of age (-2.2%, p = 0.398). Following the change in the USPSTF guidelines, mammography use among white women declined; however, no change was observed among African-American women.
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Affiliation(s)
- Jeannette Y Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sharp F Malak
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Vicki Suzanne Klimberg
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ronda Henry-Tillman
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Susan Kadlubar
- Division of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Are Physicians Influenced by Their Own Specialty Society's Guidelines Regarding Mammography Screening? An Analysis of Nationally Representative Data. AJR Am J Roentgenol 2016; 207:959-964. [PMID: 27504599 DOI: 10.2214/ajr.16.16603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to determine whether primary care physicians were influenced by their own specialty society's mammography screening recommendations after the 2009 U.S. Preventive Services Task Force's (USPSTF) revised recommendations were released. MATERIALS AND METHODS We performed an analysis of cross-sectional nationally representative data for 2007-2012 from the National Ambulatory Medical Care Survey (NAMCS). All office-based preventive services visits for women 40 years old or older were included. Multivariate regression analyses were used to identify changes over time in the mammography referral rate per 1000 visits by physician specialty, adjusting for patient- and office-level covariates. All analyses were weighted to account for the multistage probability sampling design of NAMCS. RESULTS Our analysis represented an average of 35,947,290 office visits per year. Overall, between 2007-2008 and 2011-2012, mammography referral rates (per 1000 visits) decreased from 285 to 215 referrals (-25.0% adjusted change; p = 0.006). The largest decrease was among family physicians (from 230 to 128; -49.0% adjusted change; p < 0.001), followed by internal medicine physicians (from 135 to 79; -45.8% adjusted change; p = 0.038). No statistically significant change was noted among obstetricians and gynecologists over time (from 476 to 419; -14.4% adjusted change; p = 0.23). DISCUSSION Family and internal medicine physicians, whose societies adhered to 2009 USPSTF recommendations for biennial screening starting at age 50 years, showed statistically significant decreases in mammography referral rates over time. Obstetricians and gynecologists, whose society continued to recommend annual screening starting at age 40 years, showed no statistically significant change in mammography referral rates over time. Physicians may be influenced by their own society's recommendations, which may influence their shared decision-making discussions with patients.
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Hubbard RA, O'Meara ES, Henderson LM, Hill D, Braithwaite D, Haas JS, Lee CI, Sprague BL, Alford-Teaster J, Tosteson ANA, Wernli KJ, Onega T. Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S. Prev Med 2016; 89:169-177. [PMID: 27261409 PMCID: PMC4969188 DOI: 10.1016/j.ypmed.2016.05.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/27/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66-75years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005-2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66-70years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65-2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11-1.80) compared to women with a college degree. Women with ≥1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31-1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24-1.66). Women aged 71-75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence.
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Affiliation(s)
- Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States.
| | | | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deirdre Hill
- Department of Internal Medicine and Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM, United States
| | - Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Jennifer S Haas
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Christoph I Lee
- Department of Radiology, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Brian L Sprague
- Department of Surgery, University of Vermont, Burlington, VT, United States
| | - Jennifer Alford-Teaster
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Anna N A Tosteson
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, United States
| | - Karen J Wernli
- Group Health Research Institute, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Tracy Onega
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Receipt of mammography recommendations among White and non-White women before and after the 2009 United States Preventive Services Task Force recommendation change. Cancer Causes Control 2016; 27:977-87. [PMID: 27351918 DOI: 10.1007/s10552-016-0775-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Receipt of a mammography recommendation from a physician is a strong predictor of obtaining a mammogram. In 2009, the United States Preventive Services Task Force (USPSTF) recommended routine biennial mammography for women aged 50-74 but not for women aged 40-49. We examined changes in reports of clinician recommendations for mammography among White and non-White women after these age-specific recommendations were issued. METHODS Data from women aged 40-49 and 50-74 were drawn from the 2008 and 2013 National Health Interview Surveys. We used linear probability models to determine whether the proportions of women reporting a mammography recommendation changed after the USPSTF recommendation was issued and whether any changes observed differed across White and non-White women. All analyses were stratified by age groups and mammography history. RESULTS Among women without a recent mammogram, reported clinician recommendations did not change for White women, but they decreased by 13-percentage points (95 % CI -0.22, -0.03) among non-White women aged 40-49 (p = 0.01) and increased by 9-percentage points (95 % CI 0.01, 0.17) among non-White women aged 50-74 (p = 0.04). Among women with a mammogram in the past 2 years, reported mammography recommendation from a clinician did not change for White or non-White women. CONCLUSIONS Recommendations to reduce screening may be differentially implemented across racial/ethnic groups. Changes in reports of mammography recommendation from a clinician after the USPSTF breast cancer screening recommendation change were observed only among non-White women without a recent history of mammography. It is unclear whether these differences are due to the clinician, the women, or both.
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Hirth JM, Laz TH, Rahman M, Berenson AB. Racial/Ethnic Differences Affecting Adherence to Cancer Screening Guidelines Among Women. J Womens Health (Larchmt) 2016; 25:371-80. [PMID: 26579735 PMCID: PMC4834488 DOI: 10.1089/jwh.2015.5270] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Race/ethnicity has been shown to modify the effects between obesity and cancer screening among women. The purpose of this article is to update the literature with recent data to examine how the association between different characteristics, including body mass index (BMI), and cancer screening compliance varies by race/ethnicity in a national sample of women. MATERIALS AND METHODS Three cycles of the Health Information National Trends Survey (HINTS) were combined for this cross-sectional study. Weighted descriptive statistics were evaluated using chi-square tests. Multivariable logistic regression evaluated associations between women with underweight or normal (<25), overweight (25-29.9), and obese (>30) BMIs and cancer screening concordant with guidelines (Papanicolaou [Pap] testing ≤3 years, ages 21+ years; mammography ≤2 years, ages 40+ years) in analyses stratified by race/ethnicity. We also assessed variance between racial/ethnic groups in how age, income, and insurance status were associated with cancer screening compliance. RESULTS This study included 4992 women who were evaluated for Pap testing and 3773 for mammography. In analyses stratified by race/ethnicity, whites with a higher household income were more likely to report having a Pap test (adjusted prevalence ratio [aPR] 2.16, 95% confidence interval [95% CI] 1.38-3.40) and a mammogram (aPR 1.63, 95% CI 1.04-2.55) compared to lower income white women. Black women with BMIs between 25 and 30 were less likely to receive a Pap test (aPR 0.38, 95% CI 0.19-0.76) than black women with BMIs <25, while no association was observed among the other groups. Insurance was associated with increased likelihood of Pap testing among white and black women. Insurance coverage was positively associated with mammography only among white and Hispanic women. CONCLUSIONS We found variations in adherence to cancer screening guidelines by age, insurance coverage, and income between racial/ethnic groups. Little evidence was observed for variations in screening by BMI.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas
| | - Tabassum Haque Laz
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas
| | - Mahbubur Rahman
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas
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Lantz PM, Evans WD, Mead H, Alvarez C, Stewart L. Knowledge of and Attitudes Toward Evidence-Based Guidelines for and Against Clinical Preventive Services: Results from a National Survey. Milbank Q 2016; 94:51-76. [PMID: 26994709 PMCID: PMC4941980 DOI: 10.1111/1468-0009.12181] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
POLICY POINTS Both the underuse and overuse of clinical preventive services relative to evidence-based guidelines are a public health concern. Informed consumers are an important foundation of many components of the Affordable Care Act, including coverage mandates for proven clinical preventive services recommended by the US Preventive Services Task Force. Across sociodemographic groups, however, knowledge of and positive attitudes toward evidence-based guidelines for preventive care are extremely low. Given the demonstrated low levels of consumers' knowledge of and trust in guidelines, coupled with their strong preference for involvement in preventive care decisions, better education and decision-making support for evidence-based preventive services are greatly needed. CONTEXT Both the underuse and overuse of clinical preventive services are a serious public health problem. The goal of our study was to produce population-based national data that could assist in the design of communication strategies to increase knowledge of and positive attitudes toward evidence-based guidelines for clinical preventive services (including the US Preventive Services Task Force, USPSTF) and to reduce uncertainty among patients when guidelines change or are controversial. METHODS In late 2013 we implemented an Internet-based survey of a nationally representative sample of 2,529 adults via KnowledgePanel, a probability-based survey panel of approximately 60,000 adults, statistically representative of the US noninstitutionalized population. African Americans, Hispanics, and those with less than a high school education were oversampled. We then conducted descriptive statistics and multivariable logistic regression analysis to identify the prevalence of and sociodemographic characteristics associated with key knowledge and attitudinal variables. FINDINGS While 36.4% of adults reported knowing that the Affordable Care Act requires insurance companies to cover proven preventive services without cost sharing, only 7.7% had heard of the USPSTF. Approximately 1 in 3 (32.6%) reported trusting that a government task force would make fair guidelines for preventive services, and 38.2% believed that the government uses guidelines to ration health care. Most of the respondents endorsed the notion that research/scientific evidence and expert medical opinion are important for the creation of guidelines and that clinicians should follow guidelines based on evidence. But when presented with patient vignettes in which a physician made a guideline-based recommendation against a cancer-screening test, less than 10% believed that this recommendation alone, without further dialogue and/or the patient's own research, was sufficient to make such a decision. CONCLUSIONS Given these demonstrated low levels of knowledge and mistrust regarding guidelines, coupled with a strong preference for shared decision making, better consumer education and decision supports for evidence-based guidelines for clinical preventive services are greatly needed.
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Affiliation(s)
- Paula M Lantz
- Gerald R. Ford School of Public Policy, University of Michigan
| | - W Douglas Evans
- Milken Institute School of Public Health, George Washington University
| | - Holly Mead
- Milken Institute School of Public Health, George Washington University
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James TA, Wade JE, Sprague BL. The impact of mammographic screening on the surgical management of breast cancer. J Surg Oncol 2016; 113:496-500. [PMID: 26799535 DOI: 10.1002/jso.24184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/08/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Mammographic screening has been shown to result in downward stage migration, reflected by smaller tumor sizes and less extensive nodal involvement. National guidelines restrict screening recommendations in women age 40-49. The purpose of this study is to evaluate the specific impact of mammographic screening patterns on the surgical management of breast cancer in women aged 40-49. METHODS The study is a population-based retrospective review of the Vermont Breast Cancer Surveillance System of women aged 40-49 with a diagnosis of breast cancer. Tumor stage and related characteristics at the time of diagnosis, as well as the type of surgical intervention performed were recorded for women presenting with screen-detected versus non-screen-detected breast cancer. RESULTS Screen-detected breast cancers in women aged 40-49 were associated with a greater incidence of DCIS, smaller invasive tumor size, fewer cases of positive nodes, and higher rates of breast conservation compared to non-screened women presenting with symptomatic disease. CONCLUSIONS Mammographic screening is associated with less aggressive surgical treatment of breast cancer including higher rates of breast conservation. The observed changes in surgical management should factor into individual decision-making regarding screening mammography. J. Surg. Oncol. 2016;113:496-500. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ted A James
- College of Medicine, University of Vermont, Burlington, Vermont.,Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | | | - Brian L Sprague
- College of Medicine, University of Vermont, Burlington, Vermont.,Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
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Haddad FG, Kourie HR, Adib SM. Trends in mammography utilization for breast cancer screening in a Middle-Eastern country: Lebanon 2005-2013. Cancer Epidemiol 2015; 39:819-24. [PMID: 26651440 DOI: 10.1016/j.canep.2015.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/08/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In Lebanon, annual national breast awareness campaigns were started in 2002 during the international breast month of October to promote the utilization of mammography for women aged ≥ 40. The impact of the campaigns has been assessed periodically since 2003. Results of 2003-2005 campaigns have been published previously. OBJECTIVES To measure the prevalence of two behavioral outcomes of interest: ever-use of mammography, and repeat mammography in the previous 12 months among ever-users. The prevalence was described by region and age group. The aim was to document the effectiveness of the program towards reaching a nationally defined goal of 80% screening coverage. METHODS The survey's sampling frame was developed incrementally, and since 2005 it has included women aged ≥ 40 from all areas of Lebanon. The sample size has also increased incrementally from 1200 in 2005 to 2400 in 2013. Results have been tabulated biannually and presented as historical trends with regional and demographic variations covering a 9-year period. RESULTS In all six consecutive surveys presented here, the mean age of participating women was about 50 years. Year-by-year increases in utilization indicators were detected, with consistent differences in favor of the more urban areas in and around the capital city Beirut and its suburbs (Greater Beirut or GB). By 2013, ever-utilization had reached 43% (41-45) and recent mammography 20% (18-22) nationwide. Utilization was significantly more important in the age group 50-59 compared with the age group 40-49 or ≥ 60. While recent rates have increased nationwide, they have reached a plateau of about 25% in GB and are tending to the same level in other areas. DISCUSSION AND CONCLUSIONS While initial progress was slow, it has been accelerating in the last 4-5 years, indicating that the message is being accepted by a larger audience of targeted women at each iteration. However, concern remains that women between 40 and 50 and those >60 are not responding as well as desired to the screening message, for reasons currently under investigation.
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Affiliation(s)
- Fady G Haddad
- Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon.
| | | | - Salim M Adib
- Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon
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Breast cancer screening utilization and understanding of current guidelines among rural U.S. women with private insurance. Breast Cancer Res Treat 2015; 153:659-67. [PMID: 26386956 DOI: 10.1007/s10549-015-3566-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/07/2015] [Indexed: 01/23/2023]
Abstract
Women living in rural areas of the U.S. face disparities in screening mammography and breast cancer outcomes. We sought to evaluate utilization of mammography, awareness of screening guidelines, and attitudes towards screening among rural insured U.S. women. We conducted a cross-sectional self-administered anonymous survey among 2000 women aged 40-64 insured by the National Rural Electric Cooperative Association, a non-profit insurer for electrical utility workers in predominantly rural areas across the U.S. Outcomes included mammographic screening in the past year, screening interval, awareness of guidelines, and perceived barriers to screening. 1588 women responded to the survey (response rate 79.4 %). 74 % of respondents lived in a rural area. Among women aged 40-49, 66.5 % reported mammographic screening in the past year. 46 % received annual screening, 32 % biennial screening, and 22 % rare/no screening. Among women aged 50-64, 77.1 % reported screening in the past year. 63 % received annual screening, 25 % biennial screening, and 12 % rare/no screening. The majority of women (98 %) believed that the mammography can find breast cancer early and save lives. Less than 1 % of younger women, and only 14 % of women over age 50 identified the recommendations of the U.S. Preventative Services Screening Task Force as the current expert recommendations for screening. Screening practices tended to follow perceived guideline recommendations. When rural U.S. women over age 40 have insurance, most receive breast cancer screening. The screening guidelines of cancer advocacy groups and specialty societies appear more influential and widely recognized than those of the U.S. preventative services taskforce.
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Beard C, Beard V. Re-examining current breast cancer screening: An analysis of the 2009 U.S. Preventive Services Task Force guidelines for breast cancer screening. Women Health 2015; 56:281-95. [DOI: 10.1080/03630242.2015.1088115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dehkordy SF, Hall KS, Roach AL, Rothman ED, Dalton VK, Carlos RC. Trends in Breast Cancer Screening: Impact of U.S. Preventive Services Task Force Recommendations. Am J Prev Med 2015; 49:419-22. [PMID: 25841980 PMCID: PMC4546897 DOI: 10.1016/j.amepre.2015.02.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/12/2015] [Accepted: 02/24/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although there is general agreement among various guidelines on benefits of routine screening mammography, the age of screening initiation and the optimal frequency of the test remain controversial. In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended against routine breast cancer screening in women aged younger than 50 years. In this study, screening mammography guideline adherence among U.S. women is explored by examining patterns in rates of mammography age of initiation and utilization in years prior to and following the 2009 USPSTF guideline implementation. METHODS U.S. population-based data from the 2007, 2008, 2010, and 2012 Behavioral Risk Factor Surveillance System surveys were used to measure the overall proportion and rate of change in the proportion of women who underwent screening mammography within the last year, by age and survey year. Data were accessed and analyzed in July 2014. RESULTS Rates of mammography screening were lower in 2010 and 2012 compared with 2007 and 2008 (p<0.0001). The rate of screening initiation at age 40 years increased over time and was the highest in the years following USPSTF guideline changes (p=0.012). CONCLUSIONS These data support no perceptible change in U.S. women's patterns of screening mammography age at initiation within 3 years of the USPSTF guideline revision. Whether this finding reflects a delayed effect of guideline revision in population trends or rather health provider practice and patient preference for more frequent screening is unclear and requires further investigation.
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Affiliation(s)
| | - Kelli S Hall
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine; Institute for Social Research, Population Studies Center
| | - Allison L Roach
- Department of Statistics ,University of Michigan, Ann Arbor, Michigan
| | - Edward D Rothman
- Department of Statistics ,University of Michigan, Ann Arbor, Michigan
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine; University of Michigan Institute for Healthcare Policy and Innovation
| | - Ruth C Carlos
- Department of Radiology, University of Michigan School of Medicine; University of Michigan Institute for Healthcare Policy and Innovation; University of Michigan Program for Imaging Comparative Effectiveness and Health Services Research
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Yoshino K, Karimoto M, Marzo C, Kaneshiro B, Hiraoka M. Improving the Utilization of Human Papillomavirus and Cervical Cytology Co-testing for Cervical Cancer Screening in an Obstetrics and Gynecology Resident Clinic. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2015; 74:267-269. [PMID: 26279963 PMCID: PMC4536738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Human Papillomavirus (HPV) testing in combination with cervical cytology (HPV co-testing) has been recommended for cervical cancer screening for women 30 to 65 years of age. In several studies, HPV co-testing increased sensitivity for detecting high grade dysplasia and resulted in cost-savings. This retrospective cohort study assessed the prevalence of HPV co-testing in an obstetrics and gynecology resident clinic before and after a brief educational intervention which was designed to reinforce current cervical cancer screening recommendations. The intervention consisted of a short presentation that was given to all residents and medical assistants in October 2011. The proportion of women age 30-65 years of age who had cervical cancer screening with HPV co-testing as compared to cervical cytology alone was compared before and after the intervention using chi-square tests. The goal of the intervention was to increase the percentage of patients receiving co-testing from 0.5% to 7.8%. Each arm (pre- and post-intervention) required 130 subjects to achieve 80% power with a significance of P = .05. No significant differences in demographics including age, insurance type, and cytology were noted. HPV co-testing increased from 0% to 55% (P < .001). Of the 72 subjects who had co-testing, 58 (80%) will not need cervical cancer screening for another 5 years. HPV co-testing represents an underutilized cervical cancer screening modality for women 30 years and older. This brief educational intervention, adaptable to any clinical setting, significatnly increased co-testing at the clinical site.
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Affiliation(s)
- Kurt Yoshino
- University of Hawai'i John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, Honolulu, HI
| | - Maxine Karimoto
- University of Hawai'i John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, Honolulu, HI
| | - Christina Marzo
- University of Hawai'i John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, Honolulu, HI
| | - Bliss Kaneshiro
- University of Hawai'i John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, Honolulu, HI
| | - Mark Hiraoka
- University of Hawai'i John A. Burns School of Medicine, Department of Obstetrics, Gynecology and Women's Health, Honolulu, HI
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Bleyer A. Screening mammography: update and review of publications since our report in the New England Journal of Medicine on the magnitude of the problem in the United States. Acad Radiol 2015; 22:949-60. [PMID: 26100188 DOI: 10.1016/j.acra.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 02/15/2015] [Accepted: 03/08/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES After a half century of clinical trials, expansive observations, vigorous advocacy and debate, screening mammography could not be in a more controversial condition, especially the potential harm of overdiagnosis. Despite a simple rationale (catch the cancer early and either prevent death or at least decrease the amount of therapy needed for cure), the estimates to date of overdiagnosis rates are conflicting and the interpretations complex. MATERIALS AND METHODS Since the author's 2012 publication in the New England Journal of Medicine (NEJM), the peer-reviewed publications on overdiagnosis caused by screening mammography are reviewed and the NEJM analyses updated with three additional calendar years of results. RESULTS The recent peer-reviewed medical literature on screening mammography induced overdiagnosis of breast cancer has increased exponentially, nearly 10-fold in 10 years. The average estimate of overdiagnosis is about 30%, but the range extends from 0% to 70+%. An update of the NEJM report estimates that in the US, 78,000 women and 30%-31% of those diagnosed with breast cancer at the age of 40 years or older during 2011 were overdiagnosed. CONCLUSIONS Until we have better screening procedures that identify who really has cancer and needs to be treated, the risk of overdiagnosis relative to the benefit of screening merits more effective public and professional education. Radiologists, pathologists, and other professionals involved with screening mammography should recognize that the potential harm of overdiagnosis is downplayed or not discussed with the patient and family, despite agreement that the objective is informed choice.
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Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act. PLoS One 2015; 10:e0131903. [PMID: 26121485 PMCID: PMC4487998 DOI: 10.1371/journal.pone.0131903] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
Background Practice recommendations for mammography screening were issued by the U.S. Preventive Services Task Force in 2009 and expansion of insurance coverage was provided under the Patient Protection and Affordable Care Act soon thereafter, yet the influence of these changes on screening practices in the United States is not known. Methods To determine changes in mammography screening and their associations with new practice recommendations and the Affordable Care Act, we examined patient-level data from 249,803 screening mammograms from January 1, 2008 through December 31, 2012 in a large community-based health system in the northwestern United States. Associations were determined by an intervention analysis of time-series data method. Results Among women screened, 64% were age 50-74 years; 84% self-identified as white race; 62% had commercial insurance; and 70% were seen in facilities located in metropolitan areas. Practice recommendations were associated with decreased screening volumes among women age <40 (-37.4 mammograms/month; -39.4% change; P<0.001), 40-49 (-106.0 mammograms/month; -11.2% change; P<0.001), and ≥75 (-54.7 mammograms/month; -10.0% change; P<0.001), but not women age 50-74. Implementation of the Affordable Care Act was associated with increased screening among women age 50-74 (+184.3 mammograms/month; +7.2% change; P=0.001), but not women <40 or ≥75; increases for age 40-49 were of borderline statistical significance (+56.9 mammograms/month; +6% change; P=0.06). Practice recommendations were also associated with decreased screening for women with commercial insurance, while the Affordable Care Act was associated with increased screening for women with Medicare, Medicaid, or other noncommercial sources of payment. Conclusions Mammography screening volumes in a large community health system decreased among women age <50 and ≥75 in association with new U.S. Preventive Services Task Force practice recommendations, while insurance coverage changes under the Affordable Care Act were associated with increased screening volumes among women age 50-74.
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“Do Unto Others as You Would Have Them Do Unto You”: Breast Imagers' Perspectives Regarding Screening Mammography for Others and for Themselves—Do They Practice What They Preach? AJR Am J Roentgenol 2015; 204:1336-44. [DOI: 10.2214/ajr.14.13237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis. Womens Health Issues 2015; 25:239-45. [DOI: 10.1016/j.whi.2015.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/25/2015] [Accepted: 03/04/2015] [Indexed: 11/20/2022]
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Hirth JM, Kuo YF, Lin YL, Berenson AB. Regional variation in mammography use among insured women 40-49 years old: impact of a USPSTF guideline change. ACTA ACUST UNITED AC 2015; 3:174-182. [PMID: 26661740 DOI: 10.17265/2328-7136/2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The impact of the US Preventive Services Task Force (USPSTF) recommendation that 40-49 year old women should no longer routinely receive screening mammography in November 2009 in different regions of the US is unknown. METHODS We conducted a retrospective cohort study using medical claims from administrative health records from privately insured 40-59 year old women enrolled between 2005 and 2012 to evaluate biennial screening trends. RESULTS There was a slight decrease in mammography usage among 40-49 year old US women after the 2008-2009 biennial period (p<0.001). There were some regional differences in mammography trends, with the West showing the greatest difference in odds of 40-49 year olds receiving a mammography in 2011-2012 compared to 2008-2009 (OR: 0.93; 95% CI: 0.91-0.94). Although trends for 50-59 year olds mirrored that of 40-49 year olds, the younger age group had a stronger decline in 2009-2010 and 2010-2011. CONCLUSIONS These findings show that USPSTF guideline changes made some differences in mammography usage among 40-49 year olds, but adherence was uneven across regions.
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Affiliation(s)
- Jacqueline M Hirth
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555,
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Yu-Li Lin
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555
| | - Abbey B Berenson
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Blvd Rte 0587, Galveston, TX 77555
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