Women who miss 1st breast cancer screening much likelier to die from disease
Women who miss their initial breast cancer screening exam are much likelier to die from the disease, according to new research published Wednesday.
Mammography remains the most effective tool for early detection of breast cancer, with previous studies proving its ability to reduce late-stage diagnoses and mortality. However, a knowledge gap exists regarding the long-term implications of early screening behaviors and particularly participating in the first screening visit, experts detail in The BMJ.
European researchers recently aimed to close this gap, assessing data from nearly 433,000 women invited to take part in the Swedish Mammography Screening Program between 1991 and 2020. They found that those who did not participate in the first screening had a 40% higher breast cancer mortality risk than others, a finding that persisted over 25 years.
“This increased mortality is modifiable and primarily attributed to late detection,” Wei He, PhD, with the Department of Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm, Sweden, and co-authors concluded. “Targeted interventions are warranted to boost adherence to mammography screening and decrease the mortality risk for those who did not participate in the first screening. In addition, our findings shed light on implications not only for breast cancer but also for other cancer screening programs.”
The study tracked outcomes for up to a 25-year follow-up period, calculating cumulative cancer incidence following the first screening exam. During a total of over 4.9 million person-years of follow-up, there were more than 16,000 new cases of breast cancer. Among women invited to their first mammography screening, 32% did not participate. This group was persistently less likely to attend subsequent screenings and was more likely to develop symptom-detected, late-stage cancer cases.
For instance, those who didn’t participate in the first screening faced 1.53 higher odds of developing stage 3 cancer and 3.61 higher odds for stage 4. During a total of over 6.8 million person-years of follow-up, there were more than 1,600 documented deaths from the disease. Those who didn’t attend their initial screening faced significantly higher risk of dying from breast cancer. Nonparticipants saw a 25-year cumulative mortality rate of 9.9 per 1,000 individuals compared to 7 per 1,000 for those who attended their first mammogram. This despite the 25-year breast cancer rate being similar between the two groups (7.6% in nonparticipants vs. 7.8% in others).
Researchers believe this indicates that the elevated death risk “likely reflects delayed detection, rather than increased incidence.”
“Critically, our results underscore that passive invitation policies, which do not include reminders or follow-up for nonattendees, leave first screening nonparticipants largely untouched and therefore disproportionately exposed to excess breast cancer mortality,” the authors advised. “Randomized trials have shown that simple, low-cost interventions—such as automatically scheduling a second, fixed-date appointment or offering brief telephone coaching—can markedly improve mammography screening among nonparticipants. By showing that first screening nonparticipants represent a persistently disengaged group with a 40% higher risk of breast cancer mortality, our study provides the essential justification for integrating these proactive strategies into routine mammography screening practice.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.