Only 50% of US women 40 years and older participate in annual screening mammography, even if the mammogram is covered by insurance, interrogation of a de-identified administrative claims database of more than 1.5 million women has found.

Despite the public outcry in response to the 2009 US Preventive Services Task Force (USPSTF) recommendations that the age of first mammography be lifted from 40 to 50 years, participation in annual screening is lower than expected, Milayna Subar, MD, vice president and national practice leader for oncology at Medco Health Solutions, Inc. in Franklin Lakes, New Jersey, reported at the 33rd Annual CTRC-AACR San Antonio Breast Cancer Symposium.

Dr. Subar investigated annual prevalence of mammography screening in a fully insured population of women 40 years and older at average risk for breast cancer. Among those aged 40 to 85 years, only 50% underwent the procedure in any given year. Mammography screening was found to be highest among women aged 50 to 64 years, for whom it is recommended in all published guidelines: 65% had claims for 2 or more mammograms over 4 years compared with 57% in those aged 40 to 49 years and 53% in those 65 years and older.

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To date, no major insurance company or other organization has acted on the USPSTF recommendation. Dr. Subar speculated that contributing factors to low screening rates include inconsistency of guidelines and conflicting reports regarding clinical value; in fact, she said, women are asking, “What should I do?”

Patient concerns regarding cost, procedure-related discomfort, and fear are likely to contribute to nonadherence. In addition, access to screening may limit adherence: between 2000 and 2003, the latest year for which data are available, the number of facilities that perform mammography decreased from 9,400 to 8,600 and there is an unmet demand for an increased number of specialists in breast imaging attributed both to a lack of adequate training programs and a fear of litigation.

Dr. Subar noted that continued public education and access to mammography are of utmost importance to reaching target goals for breast cancer screening.