Are women getting mammograms anyway? Utilization based on a national commercial health insurer database

Background: Recent recommendations made by the U.S. Preventative Services Task Force (USPSTF) generated much controversy. The new guidelines do not recommend routine mammograms for average-risk women in their 40s, and recommend biannual instead of annual mammograms for women 50-74 years old. This study examines the recent mammogram utilization prior to the new guidelines among a large population of women with commercial insurance.

Methods: Using longitudinal medical claims for 4.5 million women covered by a national commercial health insurer with 20 million covered lives, we examined current mammogram utilization rates across four age groups (18-39, 40-49, 50-59, and ≥60 years old) in 2006-2008. Annual and biannual mammogram rates and duration between screenings were calculated to understand how the Healthy People 2010 objectives have been met.

Results: 1.9 million out of 4.5 million women were found with any mammogram between 2006 and 2008. Screening rates within a two-year window were 9% for women aged 18-39 years and 53%, 59% and 49% for women aged 40-49, 50-59, and over 59, respectively. Among those who had two or more mammograms, the majority (56%-84%) had the most recent mammogram within 11-18 months of their previous mammogram.

Conclusions: The mammography (standard, digital, and MRI) rate is well below the guideline recommendations, especially for women aged 50-59 years, when everybody is recommended to have a mammogram at least biannually. This is especially striking for a population with continuous commercial insurance and full access to preventive care.