Behavior within a Clinical Trial and Implications for Mammography Guidelines

38 Pages Posted: 17 Sep 2018 Last revised: 31 Jul 2021

See all articles by Amanda Kowalski

Amanda Kowalski

University of Michigan at Ann Arbor - Department of Economics

Date Written: September 2018

Abstract

Mammography guidelines have weakened in response to evidence that mammograms diagnose breast cancers that would never eventually cause symptoms, a phenomenon called “overdiagnosis.” Given concerns about overdiagnosis, instead of recommending mammograms, US guidelines encourage women aged 40-49 to get them as they see fit. To assess whether these guidelines target women effectively, I propose an approach that examines mammography behavior within an influential clinical trial that followed participants long enough to find overdiagnosis. I find that women who are more likely to receive mammograms are healthier and have higher socioeconomic status. More importantly, I find that the 20-year level of overdiagnosis is at least 3.5 times higher among women who are most likely to receive mammograms. At least 36% of their cancers are overdiagnosed. These findings imply that US guidelines encourage mammograms among healthier women who are more likely to be overdiagnosed by them. Guidelines in other countries do not.

Suggested Citation

Kowalski, Amanda, Behavior within a Clinical Trial and Implications for Mammography Guidelines (September 2018). NBER Working Paper No. w25049, Available at SSRN: https://ssrn.com/abstract=3250595

Amanda Kowalski (Contact Author)

University of Michigan at Ann Arbor - Department of Economics ( email )

Ann Arbor, MI
United States

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