Decline in Mammography Observed Among Breast Cancer Survivors

Mammography rates among breast cancer survivors has been decreasing since 2009, especially among individuals aged 40 to 49 years, according to a study published by the Journal of the National Comprehensive Cancer Network.¹

Investigators found 74.4% of survivors aged 50 to 64 years received mammograms in 2004, with rates decreasing to 67.9% in 2016. Additionally, rates declined overall for survivors from 74.1% in 2004 to 67.1% by 2016. Patients who were aged 40 to 49 years had annual mammograms at a rate of 70.4% in 2004, which by decreased to 57.1% in 2016; no change occurred before 2009.

“I was surprised that we saw declines in mammography use among patients who were continuing to see their cancer specialists. It suggests we are seeing less frequent mammography participation even among those who are otherwise engaged in their cancer care. Our findings suggest we need to reinforce the importance of annual mammograms with our patients who have had breast cancer. We also need additional studies to better understand the barriers that are leading to fewer mammograms,” Kathryn P. Lowry, MD, assistant professor of Radiology at the University of Washington School of Medicine, said in the press release.2

A total of 27,456,015 patients enrolled on the trial in 2004 to 2016. Among this group, investigators identified 141,672 patients between the ages of 40 to 64 years. The median age was 53 to 54 years, and 22% to 28% of patients were 40 to 49 years old. Additionally, 63% to 69% of patients lived in predominantly White neighborhoods, 40% to 43% lived in neighbors in white 10% or more of residents were below the federal poverty line, and 39% to 46% lived in the South and 23% to 34% lived in the Midwest.

For patients who had seen an oncologist or surgeon in the previous year, the rate of mammography in 2004 was 79.1%, which declined to 70.1% in 2016 (APC, –1.7%; 95% CI, –2.1% to –1.4%). At the start of the study in 2004, patients who had previously received breast surgery had higher rates of mammography of 82.8%, but fell to 79.7% in 2016 (APC, –0.6%; 95% CI, –0.8% to –0.3%) with no signs of infection.

Changes in mammography rates was only identified in White or mixed race neighborhoods. Between 2004 to 2008, the rate of mammography for patients in predominately White neighborhoods was relatively unchanged (APC, 0.4%; 95% CI, –0.6% to 1.4%), and a decline was seen between 2008 to 2016 (APC, –1.4%; 95% CI, –1.8% to –1.1%). Those in mixed race neighborhoods had unchanged rates until 2010, when investigators observed a decline of 1.6% annually to 2016 (95% CI, –2.5% to –0.7%).

In the overall cohort, rates in neighborhoods by poverty remained relatively unchanged. However, investigators noted differences in mammography utilization by region, including 72.2% the Northeast and 63.3% in the West in 2016. Patients who had low deductibles between $0 to $500 had had a mammography decrease over the entire study period, but was more noticeable starting in 2011 (APC, –2.1%; 95% CI, –2.7% to –1.5%). Those with higher deductibles did not have a drastic change.

A sensitivity analysis found that biennial participation declined from 82.4% in 2004 to 74.1% in 2014. The APC from 2004 to 2009 was –0.5% (95% CI, –0.7% to –0.3%), while 2009 to 2016 was –1.8% (95% CI, –2.0% to –1.5%). Patients with early-stage breast cancer had higher mammography rates than the overall cohort. No detectable change from 2004 to 2008 was reported, with a 1.7% annual declined from 2008 to 2016.

Reference

1. Lowry KP, Callaway KA, Lee JM, et al. Trends in annual surveillance mammography participation among breast cancer survivors from 2004 to 2016. J Natl Compr Canc Netw. 2022;20(4):379–386 doi: 10.6004/jnccn.2021.7081
2. Concerning decline in annual screening for breast cancer survivors identified in JNCCN. News Release. National Comprehensive Cancer Network. April 7, 2022. Accessed April 7, 2022. https://bit.ly/35Y3n6M