Lack of Impact of the 2009 USPSTF Guidelines on Rates of Mammography Screening

Background: In November 2009, the United States Preventive Services Task Force (USPSTF) changed their mammography screening guidelines from recommending a screen every 1-2 years for women older than 40 years. The revised guideline recommends against regular screening for women aged 40-49 and recommends biennial screening for women aged 50-74. Research Design: We used autoregressive integrated moving-average (ARIMA) time series modeling to estimate the effect of the USPSTF 2009 guidelines on trends in screening rates. Enrollment and encounter files from the PharMetrics LifeLink+ commercial insurance claims database, years 2006-2014, were linked to determine monthly screening rates. The main outcome measure was mammography screening rates per 1,000 commercially insured women aged 40-49 or aged 50-64. Results: The study sample included 493,347 women aged 40-49 years with at least 1 month of eligibility and 658,052 women aged 50-64 years with at least 1 month of eligibility. There were 1,305,375 total screening mammograms from 2007 to 2014. Average monthly mammography screening rates from 2007 to 2014 were 40.4 per 1,000 women aged 40-49 and 54.8 per 1,000 women aged 50-64. There was a temporary decline in monthly screening rates of 11.8% and 11.2% for the 40-49 and 50-64 age groups, respectively, in the 2-month period after the guideline change (January and February 2010), but the rates quickly returned to pre-USPSTF trend levels afterward. Conclusion: Implementation of the USPSTF 2009 guidelines was not associated with a persistent long-term change in mammography screening rates over the next 5 years, despite a temporary decline of 2 months immediately following the guidelines.