Who Benefits from the 2016 U.S. Preventive Services Task Force’s Screening Mammography Recommendations? An Empirical and Philosophical Evaluation of Screening Mammography Guidelines Focused on Reducing False Positive Incidence

Detecting breast cancer in its earliest stages significantly increases the likelihood of being completely cured of the disease. Early detection via cancer mammogram screening is central to breast cancer diagnosis. There is significant controversy, however, surrounding the 2016 mammogram screening recommendation issued by the U.S. Preventive Services Task Force (USPSTF). Why? The revised recommendation cuts the frequency of screening in half and advises women to begin routine screenings 10 years later than what previous guidelines recommended. The justification for this change was that the benefits of screening mammography increase with age, while the harms—especially the risk of a false positive outcome—remain constant. This research evaluates the efficacy of the USPSTF’s decision to change screening recommendations to minimize the false positive frequency. Using a logistic regression model of data from the 2015 National Health Interview Survey, this analysis identifies the rate and demographic correlates of false positive results. From these findings, this research considers the ethical frameworks most appropriate for making policy recommendations in this arena. The results of this analysis show that younger women, who have a lower-risk of developing breast cancer compared to the average woman in their age group, have a statistically significant (p<0.001) increased risk of a false positive outcome. This paper proposes policy recommendations focused on transitioning from a selective screening framework to an individualized risk assessment framework.

Thesis Advisors: Dr. Katie Cahill and Dr. Celeste Carruthers

On Behalf of: Haslam Scholars Program, Baker Scholars Program, Economics Department