Title
Breast cancer screening: percentage of women 40 to 69 years of age who had a mammogram to screen for breast cancer.
Source(s)
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
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Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure
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Description
This measure is used to assess the percentage of women 40 to 69 years of age who had one or more mammograms during the measurement year or year prior to the measurement year.
Rationale
Breast cancer is the second most common type of cancer among American women, with approximately 178,000 new cases reported each year. It is most common in women over 50. Women whose breast cancer is detected early have more treatment choices and better chances for survival. Mammography screening has been shown to reduce mortality by 20 to 30 percent among women 40 and older. A mammogram can reveal tumors too small to be felt by hand; it can also show other changes in the breast that may suggest cancer.
The U.S. Preventive Services Task Force, the American Academy of Family Physicians, and the American College of Preventive Medicine recommend mammograms as the most effective method for detecting breast cancer when it is most treatable. When high-quality equipment is used and well-trained radiologists read the x-rays, 85 to 90 percent of cancers are detectable.
Evidence for Rationale
| AAFP periodic health examinations: summary of AAFP policy recommendations & age charts. [internet]. [updated 2005 Apr 01]; [accessed 2005 Jun 01]. |
| American Cancer Society. Cancer facts & figures 2007. Atlanta (GA): American Cancer Society; 2007. 52 p. |
Ferrini R, Mannino E, Ramsdell E, Hill L. Screening mammography for breast cancer: American College of Preventive Medicine practice policy statement. Am J Prev Med 1996 Sep-Oct;12(5):340-1. [14 references] PubMed  |
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
| US Preventive Services Task Force (USPSTF). Screening for breast cancer. [internet]. 2002 Feb [accessed 2005 Jun 24]. |
Primary Health Components
Breast cancer; screening mammography
Denominator Description
Women 42 to 69 years of age as of December 31 of the measurement year (see the related "Denominator Inclusions/Exclusions" field)
Numerator Description
One or more mammograms during the measurement year or the year prior to the measurement year (see the related "Numerator Inclusions/Exclusions" field)
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Evidence Supporting the Measure
Type of Evidence Supporting the Criterion of Quality for the Measure
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
- Breast cancer is one of the most common types of cancers, and accounts for a quarter of all new cancer diagnoses among women in the United States.
- Breast cancer is the second cause of cancer deaths in women (after lung cancer).
- Breast cancer deaths have decreased over the years, thanks to early detection using mammography. Screening every two years decreases the risk of mortality by more than 16 percent in women between 50 and 69, compared with no screening.
- About 70 to 80 percent of breast cancers occur in women who have no family history of breast cancer. These cancers occur because of genetic abnormalities that happen as a result of the aging process, and there is a clear connection between age and developing breast cancer.
- Mammogram screening has demonstrated reductions in breast cancer mortality and there is a clear connection between developing breast cancer and age.
- Early detection of breast cancer by mammography may lead to greater range of treatment options that include less-aggressive surgery and less-invasive therapy.
- The five-year survival rate for women who are diagnosed early is 98 percent, compared with the late-diagnosed breast cancer survival rate of only 23 percent.
- Breast cancer treatment costs in the U.S. total nearly $7 billion a year, including $2 billion spent on late-stage treatment. Low-income women are less likely to have had a mammogram within the past two years, increasing their risk of late-stage diagnosis and decreasing their change of survival.
- Early detection and better treatment have resulted in increased survival rates for women with breast cancer. If breast cancer is diagnosed when it is in its earliest stages, treatment may be more effective and less expensive.
Evidence for Additional Information Supporting Need for the Measure
| American Cancer Society (ACS). Cancer facts & figures 2011. Atlanta (GA): American Cancer Society (ACS); 2011. 60 p. |
| American Cancer Society. Breast cancer facts and figures 2010-2011. [internet]. 2010 [accessed 2011 May 29]. |
| BreastCancer.org. Facts and figures about breast cancer. [internet]. 2011 [accessed 2011 Jun 10]. |
| BreastCancer.org. U.S. breast cancer statistics. [internet]. 2011 [accessed 2011 Jun 10]. |
| Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ, Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 2009 Nov 17;151(10):738-47. PubMed |
| National Business Group on Health. Pathways to managing cancer in the workplace. [internet]. 2011 [accessed 2011 Jun 10]. |
| National Committee for Quality Assurance (NCQA). The state of health care quality 2011. Continuous improvement and the expansion of quality measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. 199 p. |
| Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2009 Nov 17;151(10):727-37. [32 references] PubMed |
Extent of Measure Testing
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State of Use of the Measure
State of Use
Current routine use
Current Use
Accreditation
Decision-making by businesses about health plan purchasing
Decision-making by consumers about health plan/provider choice
External oversight/Medicaid
External oversight/Medicare
External oversight/State government program
Internal quality improvement
Pay-for-reporting
Public reporting
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Application of the Measure in its Current Use
Measurement Setting
Managed Care Plans
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Allied Health Personnel
Physician Assistants
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Gender
Female (only)
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National Strategy for Quality Improvement in Health Care
National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality
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Institute of Medicine (IOM) National Health Care Quality Report Categories
IOM Care Need
Staying Healthy
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Data Collection for the Measure
Case Finding Period
December 31 of the measurement year
Denominator Sampling Frame
Enrollees or beneficiaries
Denominator (Index) Event or Characteristic
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Time window precedes index event
Denominator Inclusions/Exclusions
Inclusions
Women* 42 to 69 years of age as of December 31 of the measurement year
*Women must have been continuously enrolled during the measurement year and the year prior to the measurement year.
Allowable Gap: No more than one gap in continuous enrollment of up to 45 days during each year of continuous enrollment (commercial, Medicare). To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.
Exclusions
Exclude women who had a bilateral mastectomy or for whom there is no evidence of two unilateral mastectomies. Look for evidence of a bilateral mastectomy as far back as possible in the member's history through December 31 of the measurement year. Refer to Table BCS-B in the original measure documentation for codes to identify exclusions. (Optional)
Exclusions/Exceptions
Medical factors addressed
Numerator Inclusions/Exclusions
Inclusions
One or more mammograms during the measurement year or the year prior to the measurement year. A woman had a mammogram if a submitted claim/encounter contains any one of the codes in Table BCS-A of the original measure documentation to identify breast cancer screening.
Exclusions
The purpose of this measure is to evaluate primary screening. Do not count biopsies, breast ultrasounds or magnetic resonance imagings (MRIs) for this measure because they are not appropriate methods for primary breast cancer screening.
Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure
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Computation of the Measure
Measure Specifies Disaggregation
Does not apply to this measure
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Analysis by subgroup (stratification by individual factors, geographic factors, etc.)
Description of Allowance for Patient or Population Factors
This measure requires that separate rates be reported for commercial, Medicare, and Medicaid product lines.
Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison
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Original Title
Breast cancer screening (BCS).
Submitter
National Committee for Quality Assurance - Health Care Accreditation Organization
Developer
National Committee for Quality Assurance - Health Care Accreditation Organization
Composition of the Group that Developed the Measure
National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.
Financial Disclosures/Other Potential Conflicts of Interest
In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.
Endorser
National Quality Forum
Measure Initiative(s)
Ambulatory Care Quality Alliance (AQA)
Physician Quality Reporting System
Adaptation
This measure was not adapted from another source.
Date of Most Current Version in NQMC
2011 Jul
Date of Next Anticipated Revision
Measure Status
Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.
Source(s)
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
Measure Availability
The individual measure, "Breast Cancer Screening (BCS)," is published in "HEDIS® 2012. Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications for Health Plans."
For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .
Companion Documents
The following is available:
- National Committee for Quality Assurance (NCQA). The state of health care quality 2011. Continuous improvement and the expansion of quality measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. 199 p.
For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .
NQMC Status
This NQMC summary was completed by ECRI on July 18, 2003. The information was verified by the measure developer on October 24, 2003. This NQMC summary was updated by ECRI on June 16, 2006. The information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on November 15, 2007. The information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on March 6, 2009. The information was verified by the measure developer on May 29, 2009. This NQMC summary was updated by ECRI Institute on January 15, 2010 and again on February 16, 2011. This NQMC summary was retrofitted into the new template on June 29, 2011. This NQMC summary was updated again by ECRI Institute on May 8, 2012.
Copyright Statement
This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.
For detailed specifications regarding the National Committee on Quality Assurance (NCQA) measures, refer to HEDIS Volume 2: Technical Specifications for Health Plans, available from the NCQA Web site at www.ncqa.org .
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