U.S. Preventive Services Task Force recommendations and cancer screening among female Medicare beneficiaries

Abstract

Background: Medicare covers several cancer screening tests not currently recommended by the U.S. Preventive Services Task Force (Task Force). In September 2002, the Task Force relaxed the upper age limit of 70 years for breast cancer screening recommendations, and in March 2003 an upper age limit of 65 years was introduced for cervical cancer screening recommendations. We assessed whether mammogram and Pap test utilization among women with Medicare coverage is influenced by changes in the Task Force's recommendations for screening.

Methods: We identified female Medicare beneficiaries aged 66-80 years and used bivariate probit regression to examine the receipt of breast (mammogram) and cervical (Pap test) cancer screening reflecting changes in the Task Force recommendations. We analyzed 9,760 Medicare Current Beneficiary Survey responses from 2001 to 2007.

Results: More than two-thirds reported receiving a mammogram and more than one-third a Pap test in the previous 2 years. Lack of recommendation was given as a reason for not getting screened among the majority (51% for mammogram and 75% for Pap). After controlling for beneficiary-level socioeconomic characteristics and access to care factors, we did not observe a significant change in breast and cervical cancer screening patterns following the changes in Task Force recommendations.

Conclusions: Although there is evidence that many Medicare beneficiaries adhere to screening guidelines, some women may be receiving non-recommended screening services covered by Medicare.

FIG. 1.

Breast and cervical cancer screening: Medicare coverage and United States Preventive services Task Force (USPSTF) recommendations. USPSTF Recommendation grades: A: There is a high level of certainty that net benefit is substantial. Prior to May, 2007, the definition for grade A was the following: “The USPSTF strongly recommend that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.” B: There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Prior to May 2007, the definition for grade B was the following: “The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes the benefits outweigh harms.” D: There is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits. I: The current evidence is insufficient to assess the balance of benefits and harms of the service.