Breast cancer screening rates saw a 10% drop among several groups of women over the last 2 decades
Mammography use among women in their 40s declined by around 10% between 2002 and 2022, especially among specific sociodemographic subgroups.
Researchers recently analyzed long-term trends in mammography use among women in their 40s to determine if specific factors, including prior policies, sociodemographic status and insurance coverage, were linked to lower rates of breast cancer screening exams over the past 20 years. The findings were intentionally published two years after the United States Preventive Services Task Force (USPSTF) updated its breast cancer screening recommendations, which now suggest that women at average risk of breast cancer should begin biennial screening starting at age 40; the previous recommendation was to start at age 50.
Authors of the new JAMA paper contend that it is critical to understand how these policies impact screening uptake, especially among vulnerable and high-risk populations.
“Over the past 2 decades, breast cancer screening guidelines in the US have undergone several evidence-based revisions. Few studies have comprehensively evaluated national trends in mammography use,” Adetunji T. Toriola, MD, PhD, MPH, of the Division of Public Health Sciences at Washington University School of Medicine, and colleagues noted. “Consequently, a critical gap remains in understanding mammography use trends amid evolving screening guidelines and health system disruptions, as major Behavioral Risk Factor Surveillance System (BRFSS) methodological changes implemented in 2011, including cellular telephone sampling and raking-based weighting, may have substantially influenced prevalence estimates and were not addressed in prior trend analyses.”
The analysis included data from more than 2.6 million women included in the BRFSS, with emphasis put on how methodological changes enacted in 2009 affected screening rates among women ages 40 to 49 specifically. The impact of sociodemographic, health care access, behavioral and geographic factors also were reviewed alongside policy changes.
Though a downward trend was observed, it was not significant overall. However, in specific subgroups, screening rates dropped by up to 12%. For example, screening among women without health insurance dropped by 11.9%; rates decreased by 11.5% for Asian women, 12.1% for Hispanic or Latino women, 8.5% for non-Hispanic Black women and 9.8% for non-Hispanic White women. The observed reductions also correlated with the USPSTF’s 2009 update to its recommendations.
The group suggested that, overall, their findings indicate guideline concordance. However, the decreased screening rates among different subgroups highlight the ongoing need for outreach strategies that target vulnerable populations to ensure that all women receive the benefits of early screening.
“Our findings underscore the need for clear, risk-based screening communication and targeted strategies are needed to support guideline-concordant decision-making, ensure timely detection among younger women who may be at elevated risk, and promote equitable access to breast cancer screening,” the authors concluded.
Read more about the study's findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.