Mammography use among young women has declined in recent years

While overall mammography use did not decline significantly from 2002 to 2022, a cross-sectional study showed that there were significant declines in some subgroups.

Among more than 2 million US women, the biennial changes in mammography use from 2002 to 2022 were -0.54% (95% CI -1.25 to 0.16) for those aged 40 to 49 years and -0.16% (95% CI -0.49 to 0.16) for those aged 50 to 74 years, according to Adetunji T. Toriola, MD, PhD, explained. MPH and colleagues at Washington University School of Medicine in St. Louis jama network open.

However, younger women without health insurance (-1.54%, 95% CI -2.89 to -0.17), current smokers (-1.36%, 95% CI -2.43 to -0.27), unmarried women (-1.10%, 95% CI -1.61 to -0.59), and white women (-0.58%, 95% CI -1.09) The decline was significant. to -0.07).

Following a 2009 decision by the US Preventive Services Task Force (USPSTF) to recommend against routine screening for women aged 40 to 49, the prevalence of mammography use among this age group fell by approximately 10 percentage points – from 68.8% in 2010 to 59.2% in 2022. The biennial change in mammography use from 2010 to 2022 was significant for the following groups:

• Asian women: -2.45% (95% CI -4.20 to -0.25)
• White women: -0.88% (95% CI -1.59 to -0.16)
• Uninsured women: -2.39% (95% CI -4.57 to -0.16)

There was no significant reduction in black women (-0.59%, 95% CI -1.20 to 0.03).

“These findings can be interpreted in the context of the increasing incidence of breast cancer in women under the age of 50 in the US,” Toriola and colleagues wrote.. “Therefore, the observed decline in mammography use raises important public health concerns, particularly as young women experience increased disease burden along with the ongoing debate about the balance of screening benefits and harms.”

They added, “Our findings underscore the need for clear risk-based screening communication and targeted strategies for guideline-concordant decision making to ensure timely detection among young women who may be at high risk, even as screening guidelines continue to evolve.”

Of note, the USPSTF released new breast cancer screening recommendations in 2024, and now recommends average-risk women get a mammogram every other year between the ages of 40 and 74.

During the study period, most states saw declines in mammography use, with lower prevalence in the Western US compared to the Eastern US. The only states with statistically significant declines in younger and older age groups were Vermont, Massachusetts, and Kansas, as well as Washington, DC. Mississippi, on the other hand, saw a significant increase among young women.

The authors reported that Vermont, Massachusetts, and Washington, DC expanded Medicaid, and ranked high in health system performance, while Kansas and Mississippi did not adopt Medicaid expansion and ranked low in health system performance.

“These patterns suggest that the decline in mammography use is not explained solely by insurance coverage or overall system quality,” they wrote. “Instead, evolving guidelines, population-level approaches to screening, and state-specific health service delivery models are likely associated with the observed patterns. It also highlights that even high-performing states may experience declines in preventive service utilization.”

For this study, Torriola and team used data from CDC’s Behavioral Risk Factor Surveillance System (BRFSS), which collects information on health behaviors, chronic conditions, health care access, and use of preventive services in all 50 states, the District of Columbia, and participating territories.

They included 2,619,292 female respondents aged 40 to 74 who reported a mammogram within the past 2 years. Eligibility was based on participants’ responses to whether they had ever had a mammogram, and the time since the most recent exam.