Mammography screenings are recommended every 1-2 years for women aged 40 and older, as well as for younger women who are at high risk for breast cancer. These screenings are an essential tool for early detection and treatment of breast cancer.
Using HCCI's data on people with employer-sponsored insurance as well as Medicare and Medicaid data, we examined mammography utilization patterns from 2018 through 2020.
Three charts highlight the key findings:
Each year, mammography rates peak in October, coinciding with Breast Cancer Awareness Month.
Breast Cancer Awareness Month may affect other cancer screenings. Colonoscopies and pap smears also peak in October.
Mammography rates decreased by about 15% in 2020 compared to 2019, but rates still peaked in October 2020.
Our analysis indicates that mammography rates peak each year in October, likely reflecting increased efforts to encourage individuals to get routine breast cancer screening. In 2018 and 2019, October mammography rates were about 1.6 times the average monthly rate. In October 2020, mammography rates were lower than in either October 2018 or October 2019, consistent with other evidence that health care use dropped overall in the first year of the COVID-19 pandemic. Still, the mammography rate in October 2020 was higher than other months in the year. Specifically, the rate in October was about 1.1 times the average monthly rates in all other months in 2020 (excluding March, April, and May).
Although not as dramatic as the increase in mammograms, other cancer screenings, including pap smears and colonoscopies, also peak in October. In 2018 and 2019, October colonoscopy rates were about 1.5 times the average monthly rate, and pap smear rates were about 1.7 times the average monthly rate. In 2020, October colonoscopy and pap smear rates were both about 1.1 times the average monthly rate of all other months (excluding March, April, and May). This finding suggests that efforts to raise awareness around breast cancer screening may positively influence the likelihood that patients receive other cancer screenings.
Mammography rates in 2020 were clearly affected by the onset of the COVID-19 pandemic. In April 2020, the mammography rate was about 80% lower than the rate in April 2019. Even though rates rebounded later in the year, the average monthly mammography rate overall was 15% lower in 2020 compared to 2019. As noted above, even in 2020, mammography rates were higher in October 2020 than any other month that year. The decrease in mammography rates in 2020 is concerning, as delays in screening can result in delayed diagnoses and higher breast cancer mortality in the future.
Mammography utilization rates were calculated as the total number of services (identified by unique patient and service date combinations) divided by the total population and multiplied to calculate the rate per 100,000 enrollees. All enrollees who were identified as female in our data and between the ages of 45 and 74 were included in the denominator. Additional restrictions were made based on age by payer. The Medicare population was limited to enrollees over age 18, while the ESI population was limited to those under age 65.
The other cancer screening rates were calculated the same way as mammography utilization rates but with different age and sex restrictions. Pap smear denominators were restricted to females between the ages of 25 and 64. Colonoscopy denominators were restricted to individuals with known age and sex between the ages of 45 and 74.