title: Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations.
abstract: BACKGROUND
  It is uncertain how changes in the U.S. Preventive Services Task Force breast cancer screening recommendations (from annual to biennial mammography screening in women aged 50-74 and grading the evidence as insufficient for screening in women aged 75 and older) have affected mammography use among Medicare beneficiaries.
  
  
  METHODS
  Cohort study of 12 million Medicare fee-for-service women aged 65-74 and 75 and older to measure changes in 3-year screening use, 2007-2009 (before) and 2010-2012 (after), defined by two measures-proportion screened and frequency of screening by age, race/ethnicity, and hospital referral region.
  
  
  RESULTS
  Fewer women were screened, but with similar frequency after 2009 for both age groups (after vs. before: age 65-74: 60.1% vs. 60.8% screened, 2.1 vs. 2.1 mammograms per screened woman; age 75 and older: 31.7% vs. 33.6% screened, 1.9 vs. 1.9 mammograms per screened woman; all p < 0.05). Black women were the only subgroup with an increase in screening use, and for both age groups (after vs. before: age 65-74: 55.4% vs. 54.0% screened and 2.0 vs. 1.9 mammograms per screened woman; age 75 and older: 28.5% vs. 27.9% screened and 1.8 vs. 1.8 mammograms per screened woman; all p < 0.05). Regional change patterns in screening were more similar between age groups (Pearson correlation r = 0.781 for proportion screened; r = 0.840 for frequency of screening) than between black versus nonblack women (Pearson correlation r = 0.221 for proportion screened; r = 0.212 for frequency of screening).
  
  
  CONCLUSIONS
  Changes in screening mammography use for Medicare women are not fully aligned with the 2009 recommendations.
authors.affiliation: 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.affiliation: 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.|2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.
authors.forename: Julie P W
authors.initials: JP
authors.lastname: Bynum
authors.affiliation: 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.|3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.|3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.
authors.forename: Carrie H
authors.initials: CH
authors.lastname: Colla
authors.affiliation: 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.|2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.affiliation: 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.|2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.|3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
mesh_terms: D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D065186:Interrupted Time Series Analysis; D008327:Mammography / Q000706:statistics & numerical data* / Q000639:trends; D008403:Mass Screening / Q000706:statistics & numerical data* / Q000639:trends; D006278:Medicare; D017063:Outcome Assessment, Health Care; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D062486:Public Health Surveillance; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D012044:Regression Analysis; D014481:United States
keywords: USPSTF recommendations; change in screening; mammography; older women; race/ethnicity difference; regional variation