Screening Mammography Utilization Dropped After 2009

Screening mammography utilization abruptly declined when the U.S. Preventative Services Task Force (USPSTF) issued its screening recommendations, according to a study published in the American Journal of Roentgenology.

Researchers from Yale School of Medicine in New Haven, Conn., and Thomas Jefferson University Hospital in Philadelphia, sought to evaluate screening mammography utilization trends among the Medicare population from 2005 to 2015 and examine the volume of digital breast tomosynthesis (DBT) studies performed in 2015. This was the first year procedural billing codes for DBT were available.

Using procedure codes used for film-screen and digital screening mammography, the researchers reviewed national Medicare Part B Physician/Supplier Procedure Summary master files to determine the annual utilization rate of screening mammography. They also used the Physician/Supplier Procedure Summary master files to determine the volume of screening and diagnostic DBT studies performed in 2015.

The results showed that the utilization rate of screening mammography per 1,000 women in the Medicare fee-for-service population increased gradually every year, starting in 2005 with from 311.5 examinations to a peak in 2009 with 322.9 examinations. This represented a compound annual growth rate of 0.9 percent. The researchers noted that in 2010, the utilization rate abruptly decreased by 4.3 percent to 309.2 examinations. It has not since recovered to pre-2010 levels. In 2015, 18.9 percent of screening and 16.2 percent of diagnostic digital mammography examinations included DBT as an add-on procedure.

The researchers concluded while there was an annual increase in screening mammography utilization from 2005 to 2009, there was an abrupt sustained decline in screening that began in 2010. This coincided with the release of USPSTF recommendations. They also noted that DBT utilization was somewhat limited in 2015, occurring in conjunction with less than 20 percent of digital mammography examinations.