Overuse of Screening Mammography at an Academic Medical Center in Buenos Aires

Abstract

INTRODUCTION: Breast cancer screening in the general asymptomatic population is not recommended in women younger than 40 years old, and it is controversial among women aged 40 to 49 years. Overuse of screening mammography and its consequence, overdiagnosis, can lead to aggressive treatments. OBJECTIVE: To report the proportion of mammograms that were performed for breast cancer screening among women younger than 50 years old enrolled in a private Health Insurance Plan in Buenos Aires, Argentina. METHODS: A cross-sectional observational study was performed. Among women aged 18 to 39 and 40 to 49 years old enrolled in a private health plan (Hospital Italiano de Buenos Aires), those with a mammogram conducted in 2012 were identified. Of them, 200 in each age group were randomly selected. Their medical charts were reviewed to determine if the mammography had been performed for breast cancer screening purposes. RESULTS: During 2012, 1533 women aged 18 to 39 years old had a mammogram conducted. Of them, 200 charts were reviewed, 96 of which were determined to have a screening mammography (overuse proportion: 48%; 95% CI: 40.9-55.2%). Among women aged 40 to 49, 4 432 had a mammography performed during 2012. The charts of 199 of these women were reviewed. The mammogram had been conducted for screening purposes in 105 cases (overuse proportion: 52.8%; 95% CI: 45.6-59.9%). There was no diagnosis of breast cancer as a result of these screening mammograms. CONCLUSIONS: This high overuse of screening mammography is particularly concerning among the younger women and highlights the difficulty physicians may have to adopt the most updated guidelines.