TOPLINE:

Mammography use among women aged 40-49 years in the US declined from 69.9% in 2002 to 59.2% in 2022. Significant reductions were observed among non-Hispanic White, Asian, and uninsured women following the 2009 US Preventive Services Task Force (USPSTF) recommendation against routine screening in women in their 40s. Among women aged 50-74 years, mammography use decreased from 81.3% in 2002 to 77.0% in 2022, though this decline was not statistically significant overall.

METHODOLOGY:

• In 2024, the USPSTF updated its guidance to recommend biennial screening for women aged 40-74 years. The American Cancer Society’s 2015 guidelines recommended initiating screening at age 45, with the option to begin at age 40 according to individual preference and informed decision-making.
• Major Behavioral Risk Factor Surveillance System (BRFSS) methodological changes implemented in 2011, including cellular telephone sampling and ranking-based weighting, may have substantially influenced prevalence estimates and were not addressed in prior trend analyses.
• Researchers analyzed data from 2,619,292 women aged 40-74 years who participated in the BRFSS biennial cancer screening module from 2002 to 2022 in the US.
• Joinpoint regression with a jump model was used to calculate average biennial percentage change (ABPC) in mammography use, accounting for methodological changes in BRFSS beginning in 2011, including cellular telephone sampling and ranking-based weighting.
• Analysis stratified trends by age groups (40-49 years and 50-74 years), sociodemographic factors (race and ethnicity, education, marital status, employment, and income), healthcare access (insurance status and having a regular healthcare practitioner), behavioral characteristics (smoking status, physical activity, and self-rated health), and geographic location (state-level).
• Outcome measures included weighted prevalence of mammography use within the past 2 years and biennial percentage changes before (2002-2008) and after (2010-2022) the 2009 USPSTF recommendation, as well as prepandemic (2012-2018) vs pandemic-inclusive (2012-2022) periods.

TAKEAWAY:

• Among women aged 40-49 years, mammography use declined significantly among non-Hispanic White women (ABPC, -0.58), uninsured women (ABPC, -1.54%), current smokers (ABPC, -1.36%), and unmarried women (ABPC, -1.10%) from 2002 to 2022.
• Following the 2009 USPSTF recommendation, mammography use among women aged 40-49 years decreased significantly among non-Hispanic White women (ABPC, -0.88%), Asian women (ABPC, -2.45%), and uninsured women (ABPC, -2.39%) from 2010 to 2022, with no significant reduction among non-Hispanic Black women (ABPC, -0.59%).
• Among women aged 50-74 years, current smokers experienced significant declines in mammography use (ABPC, -0.52%) from 2002 to 2022, while overall biennial changes were not statistically significant (ABPC, -0.16%).
• Geographic variation was pronounced, with consistently lower mammography use in Western US states than Eastern states and significant state-level declines observed in Vermont (ABPC, -1.75%) and New Mexico (ABPC, -1.59%) among women aged 40-49 years.

IN PRACTICE:

“Declining mammography use among subgroups of younger US women underscores the need for clear, risk-based screening communication and targeted strategies to support guideline-concordant decision-making,” wrote the authors of the study.

SOURCE:

The study was led by Syed Mahfuz Al Hasan, PhD, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis. It was published online on March 26 in JAMA Network Open.

LIMITATIONS:

Mammography use was self-reported, which may introduce recall and social desirability bias, though self-report remains the standard approach in large-scale surveillance. BRFSS does not distinguish between screening and diagnostic mammography, nor does it capture cancer stage, tumor characteristics, or outcomes, precluding direct assessment of whether declines in mammography use were associated with increased advanced-stage disease or mortality. The cross-sectional design limits causal inference at the individual level. The survey lacks data on individual medical history, practitioner recommendations, and facility-level availability, which may influence screening behavior. Biennial measurement may underestimate transient pandemic-related declines, and joinpoint estimates are sensitive to the selected time frame.

DISCLOSURES:

No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.