Mammography Screening and Screening Behavior Open Access

Abstract

In November 2009, the US Preventive Services Task Force (USPSTF) revised the 2002 recommendation regarding mammography screening to recommend against routine mammography screening for women aged 40-49 due to considerations of the harm of mammography screening. This revised recommendation is highly controversial, and has led to confusion regarding mammography screening among both physicians and women. To address the controversy and the confusion it caused, this study aims to examine the impact of the revised recommendation on mammography screening rates and the impact of the false-positive mammogram on screening behavior. The private insurance outpatient claims data from 2006 to 2011 were used to establish study samples. A difference-in-difference approach was applied to examine the impact of the revised recommendation on screening rates among women aged 40-49. Survival analyses were conducted to estimate the impact of a false-positive mammogram on screening behavior. Among women aged 40-49, biennial mammography screening rates declined by 1.15 percentage point between 2008-2009 and 2010-2011(P<0.0001). With women who had enrolled in private insurance programs from 2006 to 2011, false-positive rates were slightly higher among women aged 40-49 than among women aged 50-59 (2.5% vs. 2.3%, P<0.001). The likelihood of rescreening among women who had a false-positive mammogram that requires a biopsy was 20.5% lower than that among women who did not have any false-positive mammograms (P<0.0001). Findings suggest that the revised recommendation led to a reduction in mammography screening rates, and that false-positive mammograms that require a biopsy have a negative impact on continuing mammography screening.

Table of Contents

Table of Contents

Introduction 1

Literature Review 3

Trends of Mammography Screening Rates in the US 3

The Impact of Breast Cancer Screening Guidelines 4

History of the USPSTF Breast Cancer Screening Recommendations 5

Impact of the 2009 Revised USPSTF Breast Cancer Screening Recommendation 6

Conclusion 8

Methodology 10

Research Questions 10

Hypotheses 11

Data 11

Research Question 1 12

Research Question 2 14

Results 17

Research Question 1 17

Research Question 2 21

Discussion 24

Summary 24

Limitations 25

Future Research 27

Policy Implications 28

Conclusion 30

Reference 31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Health Care Management
Keyword	Mammogram USPSTF False-positive
Committee Chair / Thesis Advisor	Howard, David H, Emory University
Committee Members	Gaydos, Laurie, Emory University Lipscomb, Joseph, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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