Online Program

Age-normativity and risk-sensitivity in the utilization of mammography screening: Before and after the 2009 issuance of The US preventive Services Task Force (USPSTF) breast cancer guidelines

Monday, November 2, 2015

Katsuya Oi, M.A., Department of Sociology, The Pennsylvania State University, University Park, PA
The US preventive Services Task Force (USPSTF) published updated guidelines in November 2009. The departure of the USPSTF from the pre-existing guidelines is significant in that it recommends biannual mammography for women aged between 50 and 75, instead of annual screening for those aged 40 or older.  Many speculations about future trends in mammography use sprang, although evidence is limited.  Using the 2005 and 2010 National Health Interview Survey (NHIS) data, the paper focuses on potential changes in the roles of chronological age and objective/subjective breast cancer risk in determining the use of biannual screening between the two time periods. The measurement of objective breast cancer risk is based on absolute risk estimated by the Breast Cancer Risk Assessment SAS macro. Age-and-race adjusted risk ratios are then calculated for the NHIS sample of women aged 30 or older. A series of logistic regression models are used to predict mammography use in the past 2 years. We condition the effects of age and risk by physician recommendation. To adjust for its selection bias, a regression-based application of propensity-score matching is used.  We observe that a rate of routine mammography has declined since 2005, and also that mammography use became particularly lower among women older than 75. The latter finding suggests assimilation to the USPTF recommended age range. Our evidence does not confirm that physicians and patients weigh breast cancer risk any differently between 2005 and 2010. The influence of subjective risk is largely through recommendation, while objective risk directly determines mammography use.

Learning Areas:

Provision of health care to the public
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Define age/race adjusted individual breast cancer risk with the BCRAM SAS Macro based on NHIS data. Describe a strong tie between chronological age and mammography use, and how it changed after the 2009 USPSTF guidelines.Formulate insightful strategies for effective use of mammography that reflects individual breast cancer risk. Define an analytic framework to assess how our health care system responds to individual risk and how patients translate risk into screening behavior.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Ph.D candidate in Sociology and Demography and an affiliate of the Population Research Institute at the Pennsylvania State University. One of my interests is to develop an analytic framework that better explains health behavior and physician-patient relationship with innovative use of measurements.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.