Women starting mammography on time, but failing to follow up

A new study finds most women now follow the recommendation to receive their first screening mammogram at age 40, but there is widespread failure to return promptly for subsequent exams and several sub-populations of women still are not being screened by the recommended age.

The authors say their findings, published September 13, 2004 in the online edition of CANCER, a peer-reviewed journal of the American Cancer Society, suggest there is little to be gained from population-wide efforts to encourage entry into the screening process, and that public health efforts should focus on the sub-populations at highest risk of inadequate screening.

While annual screening mammography for breast cancer has been demonstrated to save lives and is recommended for women 40 and over by the American Cancer Society, the American College of Radiology, and the American Medical Association, recent studies demonstrate that relatively few women over 40 actually have screening mammograms every year. Also, no studies have investigated at what age women actually begin screening. James Michaelson, Ph.D., of Massachusetts General Hospital (MGH) led a team of investigators to assess the long-term pattern of screening mammography use by 72,417 women at the MGH Avon Comprehensive Breast Center between 1985 and 2002.

The study's data were reassuring. Over 60 percent of women had their first mammogram by age 40 and 90 percent by age 50. Specific sub-populations, however, delayed mammography. Women who did not speak English did not begin screening mammography until a median age of 49. Women who did not have private health insurance did not begin screening until age 46. Women who did not speak English and who did not have private health insurance did not begin screening until a median age of 55. Women without a primary care doctor began at age 42. African-Americans, Hispanics and obese women began at age 41.

Only 16 percent of women had five mammograms in five years, while only 8 percent of Hispanic women and 11 percent of African-American women returned for screening every year. In contrast, 19 percent of Caucasian women completed annual mammograms. The study found approximately one third of the women studied received their first mammogram between the ages of 35 and 40. Almost half the women with private insurance began screening before age 40.

The authors conclude that the "need to find ways to encourage women to start screening may be less critical than the need to encourage them to return promptly once they have begun screening."