Mammography Use Declined Among Younger Women in Recent Years

While mammography use did not significantly decline overall from 2002 to 2022, there was a significant drop in certain subgroups, a cross-sectional study showed.

Among over 2 million U.S. women, biennial changes in mammography use were -0.54% (95% CI -1.25 to 0.16) for those ages 40 to 49 and -0.16% (95% CI -0.49 to 0.16) for those ages 50 to 74 from 2002 to 2022, reported Adetunji T. Toriola, MD, PhD, MPH, of Washington University School of Medicine in St. Louis, and colleagues in JAMA Network Open.

However, declines were significant among young 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 to -0.07).

Following the decision by the U.S. Preventive Services Task Force (USPSTF) in 2009 to recommend against routine screening for women ages 40 to 49, the prevalence of mammography use among this age group fell by almost 10 percentage points — 68.8% in 2010 to 59.2% in 2022. The biennial change in mammography use from 2010 t0 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 among Black women (-0.59%, 95% CI -1.20 to 0.03).

“These findings can be interpreted within the context of increasing breast cancer incidence among women younger than 50 years in the U.S.,” wrote Toriola and colleagues. “The observed reductions in mammography use, therefore, raise important public health considerations, particularly as younger women experience rising disease burden alongside ongoing debates about the balance of screening benefits and harms.”

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

Of note, the USPSTF in 2024 issued new breast cancer screening recommendations, and now recommend women at average risk have a mammogram every other year from ages 40 to 74 years.

Over the study period, most states experienced a downward trend in mammography use, with a lower prevalence in the Western U.S compared with the Eastern U.S. The only states with statistically significant declines in the younger and older age groups were Vermont, Massachusetts, and Kansas, as well as Washington, D.C. On the other hand, Mississippi showed a significant increase among younger women.

The authors pointed out that Vermont, Massachusetts, and Washington, D.C. have expanded Medicaid, and rank high in health system performance, while Kansas and Mississippi did not adopt Medicaid expansion and rank low in health system performance.

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

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

They included 2,619,292 female respondents ages 40 to 74 years 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 examination.