Mammography Screening Rates on the Decline Since 2009 Among Breast Cancer Survivors

A new study found a concerning and steady decline in mammography rates since 2009, particularly among younger survivors of breast cancer.

The authors of the study, published in JNCCN—Journal of the National Comprehensive Cancer Network, analyzed a nationwide commercial claims database for annual mammography rates among individuals from 40 to 64 years of age who have a prior breast cancer diagnosis.

Among patients between 50 and 64 years of age, the researchers found approximately 74% received annual mammograms from 2004-2009, which dropped to 67% by 2016. Among breast cancer survivors aged 40 to 49 years, the rates of annual mammography were 70% from 2004-2009 but fell to 57% by 2016.

Overall, the study showed that annual mammography rates fell by approximately 1.5% per year from 2009-2016; however, the rate of decline increased to 2.8% in the patient group aged 40 to 49 years. The investigators noted that this is particularly concerning because younger patients are more likely to develop aggressive tumors and also have a longer remaining life expectancy.

“Most people do quite well after completing their treatment for breast cancer, however some will have a recurrence of their prior cancer or develop a new breast cancer. Mammography is an important tool for detecting these cancers earlier, when they are smaller and more easily treated,” lead researcher Kathryn P. Lowry, MD, assistant professor of Radiology at the University of Washington School of Medicine, said press release. “I was surprised that we saw declines in mammography use among patients who were continuing to see their cancer specialists. It suggests we are seeing less frequent mammography participation even among those who are otherwise engaged in their cancer care. Our findings suggest we need to reinforce the importance of annual mammograms with our patients who have had breast cancer. We also need additional studies to better understand the barriers that are leading to fewer mammograms.”

These findings were evaluated by recency of surgery or primary care visit, neighborhood racial and socioeconomic demographics, geographic region, and deductible costs. However, the investigators noted that the results did not allow them to conclude which specific factors are responsible for the drop in mammography rates.

“More research—through qualitative interviews—is needed to further define the barriers to care and optimal strategies for improved mammography retention in survivorship,” said Amy M. Sitapati, MD, UC San Diego Moores Cancer Center, who was not involved in this research.

The investigators further noted that these findings highlight the crucial role of longitudinal tracking of breast cancer survivors, including mammographic screening. They added that the current system does not strategically prioritize and contact survivors via standardized and highly reliable processes.

It was noted that the time in which the study was concluded occurred prior to the start of the COVID-19 pandemic, which has been found to further erode cancer screening in general.

“The downward trend in adherence to annual mammography in survivorship should serve as a call to action for new processes that identify and engage breast cancer survivors,” Sitapati said in a press release. “Electronic medical records-based registries could serve a pivotal role for long-term follow-up with survivors.”