Biennial Mammogram Screening and Behavioral Factors

The U.S. Preventive Services Task Force (USPSTF) new mammogram recommendations include biennial screening for women between the ages of 50 and 74. Prior recommendations were for an interval as short as one year and up to two. My experience suggests that two-year intervals are tricky, and I speculate that behavioral factors could lead to actual intervals that are much longer.

I’m young(ish) and healthy. Therefore, my primary care doctor recommends I visit him only ever other year, as opposed to the more customary annual visits most older and/or sicker individuals experience. But his office’s scheduling software does not permit visits to be booked more than one year out (he works at a large, sophisticated hospital). Therefore, instead of scheduling my next visit while I’m paying my co-pay, I have to remember to do so one year later (for the next year). By the way, my childrens’ pediatrician’s office cannot schedule beyond one year either. So this seems to be a common problem.

That’s not so good. How many people can remember to make a phone call in one year to schedule something that won’t occur for two years? The task is easier with modern personal electronic calendars, but I doubt a very large fraction of the population can manage this. The only way to make it work is for the physician’s office to handle it and, right now, I’m skeptical many can (extrapolating from my own experience).

Fundamentally there are behavioral considerations here. One year intervals are somewhat easy to keep track of. Anything longer isn’t. Will implementation of biennial mamogram screenings actually lead to much longer intervals? Is it possible that annual screenings are preferable just for behavioral reasons? I think it is at least plausible that the answers are “yes” to both of these. This would seem to be a good topic for behavioral economists. (I know a few…stay tuned.)

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