Mammography utilization declined due to revised USPSTF breast cancer screening guidelines

Screening mammography utilization dropped in 2010 after years of growth, according to a new study published in the American Journal of Roentgenology. The decline in utilization, the authors noted, seems to have been brought on by revised breast cancer screening guidelines released by the U.S. Preventive Services Task Force (USPSTF) in 2009.

The authors studied Medicare Part B Physician/Supplier Procedure Summary data from 2005 to 2015. Screening mammography utilization per 1,000 Medicare fee-for-service beneficiaries was 311.5 in 2005 and 322.9 in 2009 before dropping more than 4 percent to 309.2 in 2010. The utilization rate was 300.9 in 2015.

“Our findings show that, in contrast to the steady annual increase in national screening mammography utilization from 2005 to 2009, an abrupt and sustained decline in screening started in 2010, coinciding with the release of the USPSTF recommendations,” wrote Gilda Boroumand, MD, with the department of radiology and biomedical imaging at Yale School of Medicine in New Haven, Connecticut, and colleagues. “The persistent decline in utilization rates, despite conflicting recommendations from the American College of Radiology, the American Cancer Society, and the American College of Obstetricians and Gynecologists, suggests a lasting influence of the USPSTF guidelines.” 

Boroumand et al. also studied digital breast tomosynthesis (DBT) utilization since its approval for clinical use in 2011. “Our study also shows rather limited utilization of DBT in 2015 (the first year for which hard data are available), occurring in conjunction with less than 20 percent of digital mammography examinations,” the authors wrote. “Publicly available data from the FDA's Mammography Quality Standards Act national statistics suggests that our reported DBT utilization in 2015 is in line with the number of Mammography Quality Standards Act–accredited DBT units.”

Though they described that DBT utilization number as “rather limited,” the authors concluded that the future of DBT still looks strong. “As the literature in support of the clinical efficacy of DBT grows, all while more states enact legislation requiring insurance reimbursement for DBT and more payers independently begin to reimburse for DBT studies, utilization of DBT will almost surely increase,” they wrote. “The development of clinical guidelines for DBT use and standardization of reimbursement would help steer the adoption of this technology. It will be important to follow the use of DBT in future years.”