Conflicting national guidelines for mammography result in longer time intervals in between mammograms

Background: Mammography is a screening tool used by clinicians to prevent breast cancer. The US Preventive Services Task Force (USPSTF) released new breast cancer screening guidelines in the fall of 2009 advising against routine mammography in women 40 to 49 years, and recommending biennial screening mammography for women aged 50 to 74. There has been controversy surrounding the timing of mammography amongst organizations and the quality health measures set forth by the National Committee for Quality Assurance (NCQA) and their Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS measures preventive performance dimensions, requiring preventive mammography yearly for women aged 40-69. The conflict in standards by these governing entities affects funding for Federally Qualified Health Clinics (FQHC), as they receive funding based on compliance of these quality health measures. Given this discrepancy, FQHC, clinicians and patients are deprived of a clear methodology for preventive practices. Purpose: This study assesses the time intervals between screening mammograms for women at Clinic Ole (a FQHC) in Napa, California from 2007-2011. The goal is to ascertain if the changes in USPSTF proposed guidelines effects the time interval of women receiving screening mammograms. Methods: This cross sectional study used the date of women's breast mammogram to discern the time interval between their screenings. Microsoft Excel was used to analyze 340 Clinic Ole mammogram results from 1/2007-9/1/2009 and 690 breast mammogram results from 9/2/2009-12/2011. Mammogram follow-ups that exceeded a 28 month screening interval were not included in the data set. No personal information was used to identify patients. Results: Prior to the USPSTF guideline change, 43.53% of women received their mammogram following one year, and 1.47% of women received their mammograms following two years. By comparison, post guideline change, 30% of women received their mammogram annually, while 9.13% of women received their mammogram every two years. Discussion: After the USPSTF guideline change, there was a decrease in women receiving annual mammograms, and an increase in women receiving their mammograms every 2 years. Inconsistent guidelines for breast cancer screening and misaligned performance goals from NCQA's HEDIS puts FQHC's in a difficult financial position. The mammogram patterns observed at Clinic Ole suggests that functioning under USPSTF guidelines and operating in accordance with preventive health measures is not fiscally desirable. Ultimately, this makes mammogram screening a cost effectiveness concern of significant consequence for FQHC's.