Only half of women over 40 get mammograms

Remember the uproar last year when a government task force said most women don't need annual mammograms? It turns out that only half of women over 40 had been getting them that often to start with, even when they have insurance that covers screening.

The information comes from a review of insurance claims that show what women actually do — not what they say in surveys.

"We all support many things — fast food isn't what we should eat for dinner every night — but that isn't what we do," said Dr. Milayna Subar of Medco Health Solutions Inc., which manages benefits for many large insurers, including some Medicare plans.

She did the study, using records on more than 1.5 million women, and reported results Thursday at a breast cancer conference.

"Our study suggests that even among an insured population, many women do not meet that target, and a surprising number do not even have one mammogram in four years," said Subar.

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The finding is disturbing, said Dr. Judy Garber of Dana-Farber Cancer Institute in Boston and president-elect of the American Association for Cancer Research, one of the conference's sponsors. "Here's an insured population where cost is not a barrier," and yet many women are not getting tested.

Rates of screening are likely even lower among women without insurance, though government programs pay for mammograms for many women who lack such coverage.

Controversy over guidelines
In 2009, the U.S. Preventive Services Task Force's controversial guidelines recommended against routine mammograms for women in their 40s, saying women in their 50s should get mammograms every other year instead of annually.

The guidelines contradicted years of messages about the need for routine breast cancer screening starting at age 40, kicking off a fury of protest among breast cancer experts and advocacy groups who argued the recommendation of fewer screenings would confuse women and result in more deaths from breast cancer.

They were meant to spare women some of the worry and expense of extra tests needed to distinguish between cancer and harmless lumps.

Many groups, including the American Cancer Society, still advise annual mammograms starting at 40.

After the recommendations were released, U.S. Health and Human Services Secretary Kathleen Sebelius said the task force did not set federal policy and did not affect what services the government would pay for.

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Subar said many groups feared insurance companies would stop covering yearly mammograms for women in their 50s.

Mammograms are X-rays of the breast that can reveal tumors when they're too small to be felt. But they also raise many false alarms, leading to worry, expense and overtreatment. How often and when women should get mammograms has long been controversial.

Everyone agrees that the age group that most benefits from mammograms is women 50 to 64, and the government estimates that roughly three-quarters of women in this age group had a mammogram within in the previous two years, based on surveys.

However, the review of insurance claims from 2006 through 2009 put the true number at 65 percent. It also found that only 54 percent of women in this age group had been getting mammograms every year.

Among all women 40 to 85, only half had been getting annual mammograms, the study found.

Use what we have
Doctors will not be surprised by these results, said Dr. Peter Ravdin of the University of Texas Health Science Center at San Antonio, one of the organizers of the cancer conference. Women forget or lose track of when they last had a mammogram, and that's one of the downsides of advice not to go every year, he said. Some may even lie when asked how often they go.

"There's both a conscious and mostly unconscious desire to please the person asking that question," because most women know they should be getting one, Ravdin said.

Dr. Marisa Weiss, a 51-year-old Philadelphia breast cancer specialist who founded the consumer Web site breastcancer.org, is glad she had been following her own advice to get screened every year. She was diagnosed in April with breast cancer found through a routine mammogram.

"It was a very favorable diagnosis and I feel very lucky about that. I was a true beneficiary of early detection," she said.

If she'd followed advice to get screened just every two years, it could have meant "a real difference in my prognosis," Weiss said.

"Nobody took away the coverage, but we need to use what we have," Subar said in a telephone interview.

She said the debate over mammograms may further discourage women from getting routine screenings.

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Dr. Marisa Weiss, founder and president of Breastcancer.org, said in a statement the findings provide evidence that breast cancer advocates need to do a better job of encouraging women to have regular mammograms.

"Mammography detects 80 to 90 percent of breast cancers in asymptomatic women; so while it is not a perfect detection tool, it's the best we currently have for saving lives and finding cancers at an early stage so that less toxic and traumatic treatments are required," Weiss said.

Breast cancer is the second-leading cause of cancer death among U.S. women, after lung cancer. It kills 500,000 people globally every year and is diagnosed in close to 1.3 million people around the world.