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. 2015 Jun 29;10(6):e0131903.
doi: 10.1371/journal.pone.0131903. eCollection 2015.

Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act

Heidi D Nelson  1 , Roshanthi Weerasinghe  2 , Lian Wang  3 , Gary Grunkemeier  3
Affiliations

Mammography Screening in a Large Health System Following the U.S. Preventive Services Task Force Recommendations and the Affordable Care Act

Heidi D Nelson et al. PLoS One. .

Abstract

Background: Practice recommendations for mammography screening were issued by the U.S. Preventive Services Task Force in 2009 and expansion of insurance coverage was provided under the Patient Protection and Affordable Care Act soon thereafter, yet the influence of these changes on screening practices in the United States is not known.

Methods: To determine changes in mammography screening and their associations with new practice recommendations and the Affordable Care Act, we examined patient-level data from 249,803 screening mammograms from January 1, 2008 through December 31, 2012 in a large community-based health system in the northwestern United States. Associations were determined by an intervention analysis of time-series data method.

Results: Among women screened, 64% were age 50-74 years; 84% self-identified as white race; 62% had commercial insurance; and 70% were seen in facilities located in metropolitan areas. Practice recommendations were associated with decreased screening volumes among women age <40 (-37.4 mammograms/month; -39.4% change; P<0.001), 40-49 (-106.0 mammograms/month; -11.2% change; P<0.001), and ≥75 (-54.7 mammograms/month; -10.0% change; P<0.001), but not women age 50-74. Implementation of the Affordable Care Act was associated with increased screening among women age 50-74 (+184.3 mammograms/month; +7.2% change; P=0.001), but not women <40 or ≥75; increases for age 40-49 were of borderline statistical significance (+56.9 mammograms/month; +6% change; P=0.06). Practice recommendations were also associated with decreased screening for women with commercial insurance, while the Affordable Care Act was associated with increased screening for women with Medicare, Medicaid, or other noncommercial sources of payment.

Conclusions: Mammography screening volumes in a large community health system decreased among women age <50 and ≥75 in association with new U.S. Preventive Services Task Force practice recommendations, while insurance coverage changes under the Affordable Care Act were associated with increased screening volumes among women age 50-74.

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Conflict of interest statement

Competing Interests: Dr. Nelson receives funding support from the Agency for Healthcare Research and Quality to conduct systematic reviews for the U.S. Preventive Services Task Force and from the National Cancer Institute for research related to breast cancer screening and diagnosis; the authors have no other potential competing interests. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Screening Mammography Changes for Women <40 and 40–49.
The mean number of screening mammograms per month performed in the health system from 2008 through 2012. Arrows indicate the times of new screening recommendations and implementation of the Affordable Care Act. Recommendations were associated with decreased screening for women <50, while the Affordable Care Act had no statistically significant associations.
Fig 2
Fig 2. Screening Mammography Changes for Women 50–74 and ≥75.
The mean number of screening mammograms per month performed in the health system from 2008 through 2012. Arrows indicate the times of new screening recommendations and implementation of the Affordable Care Act. New recommendations were not associated with changes for women age 50–74, but were associated with decreased screening for ≥75, while the Affordable Care Act was associated with increased screening among women age 50–74 and no changes for ≥75.
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References

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Publication types

Grants and funding

This study was funded by the Safeway Foundation and the Providence Cancer Center Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.