title: Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis.
abstract: OBJECTIVE
  We sought to examine longitudinal trends in screening mammography utilization and the presence of any changes in utilization associated with the 2009 U.S. Preventive Services Task Force (USPSTF) guideline change.
  
  
  METHODS
  We use 2005 through 2012 Medicare fee-for-service claims data for a 5% sample of randomly selected beneficiaries. The primary outcome is monthly mammography rate per 1,000 women. Two comparison outcomes are monthly Papanicolaou test rate and monthly routine eye examination rate. The statistical approach is interrupted time series with segmented regression analysis and nonequivalent dependent variables.
  
  
  RESULTS
  Among women age 65 and 90, monthly screening mammography rates were significantly increasing before the 2009 USPSTF guideline change. Immediately after the guidelines, there was a significant drop of 1.76 per 1,000 women (p < .001). Three years after the guideline, and after the initial decrease, there was no significant change in rate for those aged 65 to 74, but a continued and significant decline for those aged 75 and older. Two other preventive services (Papanicolaou test and routine eye examinations) did not show any shift associated with the pre- and post-guideline window.
  
  
  CONCLUSIONS
  The 2009 revision of USPSTF guidelines on breast cancer was associated with an immediate and significant decrease in screening mammography rates. The long-term impact of the guideline change differs by age and race and may not be fully quantifiable for years after its implementation.
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. Electronic address: mjiang@neimanhpi.org.
authors.forename: Miao
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia.
authors.forename: Danny R
authors.initials: DR
authors.lastname: Hughes
authors.affiliation: Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Richard
authors.initials: R
authors.lastname: Duszak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D065186:Interrupted Time Series Analysis; D008137:Longitudinal Studies; D008327:Mammography / Q000706:statistics & numerical data* / Q000639:trends; D008403:Mass Screening; D006278:Medicare; D062486:Public Health Surveillance; D012042:Registries; D012044:Regression Analysis; D014481:United States