Presentation (CTI)

OBJECTIVES: In April 2024, the US Preventive Services Task Force (USPSTF) updated its breast cancer screening guidelines to recommend biennial mammography for women aged 40-74 years, lowering the recommended age to initiate screening from 50 to 40. Because private insurers are required to align coverage with USPSTF recommendations, this policy change may influence screening utilization among women in their 40s. This study describes the changes in the prevalence of screening mammography among women aged 40-49 compared with women aged 50-64 before and after the guideline update.
METHODS: We conducted a descriptive observational analysis using MarketScan Treatment Pathways data. Three annual cohorts were defined by index dates of May 1 in 2022, 2023, and 2024, each requiring 365 days of continuous enrollment. These periods correspond to pre-draft (2022), draft (2023), and post-final (2024) USPSTF recommendations. Women aged 40-64 years were stratified into two groups: 40-49 years (policy-relevant) and 50-64 years (comparison). Screening mammography was identified using claims-based procedure codes, and annual screening prevalence was calculated as the proportion of women with ≥1 screening mammogram during follow-up.
RESULTS: Across the three cohorts, over 6 million women aged 40-64 years were included. Screening mammography prevalence among women aged 40-49 increased from 42.8% (2022) to 44.3% (2023) and 44.9% (2024), while prevalence among women aged 50-64 was stable at 50.1% (2022), 51.3% (2023), and 50.2% (2024). This resulted in a narrowing absolute difference in screening rates between age groups following the final USPSTF recommendation.
CONCLUSIONS: Screening mammography prevalence increased following the April 2024 USPSTF guideline update among women aged 40-49, while screening prevalence among women aged 50-64 remained relatively stable across cohorts. Although screening prevalence remained lower among women aged 40-49, the narrowing gap between age groups suggests evolving screening patterns following guideline implementation. Continued monitoring is needed to assess longer-term trends.