Dr. Newman
Lisa A Newman, MD
Director of the Breast Oncology Program for the multi-hospital
Henry Ford Health System
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In 2009 the United States Preventive Services Task Force published a guideline recommending that American women at average risk for breast cancer defer undergoing screening mammography until they reach the age of 50 years. Prior to this publication, women were widely-encouraged to initiate annual mammography at age 40 years. Women that have a history of breast cancer are automatically considered to be at increased risk for developing a new breast cancer, and so routine screening mammography guidelines do not apply to them. These women require annual mammography regardless of age, unless they have undergone a bilateral mastectomy.
We utilized data from Michigan Blue Cross/Blue Shield to evaluate patterns of mammography utilization among women age 40-49 years, comparing rates before versus after 2009, when the USPSTF guideline was published. We analyzed women that had a prior history of breast cancer separately from those that had no history of breast cancer, and we excluded women that underwent bilateral mastectomy.
Disturbingly, we found that mammography utilization rates declined among women with a history of breast cancer as well as among those with no history of breast cancer in the post-2009 timeline.
This suggested to us that changes in screening recommendations may have had the unintended consequence of generating confusion and misunderstandings regarding the value of mammography among women that undeniably benefit from this imaging, such as those with a history of breast cancer.
MedicalResearch.com: What should readers take away from your report?
Response: It is essential for the public to understand that “routine” mammography screening recommendations for “average-risk” women do NOT pertain to women that have a history of breast cancer. Furthermore, all women should discuss their individual breast cancer screening needs with their primary care providers. Family history of breast cancer, prior history of chest wall radiation, and certain prior benign breast biopsy findings as well as a personal history of breast cancer, are all factors that might influence the frequency at which screening breast imaging is necessary.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We would like to extend this research to look at patterns of mammography utilization in other states aside from Michigan, in extended time intervals, and among women with other insurance coverages. Since African American women face an increased risk of developing breast cancer at young ages compared to White American women, we would also like to evaluate patterns of mammography utilization stratified by racial-ethnic background.
Disclosures: I have no conflicts of interest to disclose.
Citation:
Bensenhaver JM, Perez Martinez AP, Albert PG, Hawley ST, Petersen LF, Newman LA. Trends in Mammography Use Among Women Aged 40 to 49 Years With a History of Breast Cancer. JAMA Surg. Published online August 22, 2018. doi:10.1001/jamasurg.2018.2690
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