New mammography research reveals an approximately eight to 10 percent decline in mammography use among women in their 40s between 2008 and 2022, which may have resulted from a 2009recommendation from the United States Preventive Services Task Force (USPSTF) against routine mammography screening in this cohort.
For the cross-sectional study, recently published in JAMA Network Open, researchers reviewed mammography use data for 2,619,292 women in the United States over a 20-year period from 2002 to 2022 from the Behavioral Risk Factor Surveillance System (BRFSS).
From mammography use among women 40-49 years of age from 2008 to 2022, the study authors noted:
• an 11.5 percent decrease for Asian women (from 66.9 percent to 55.4 percent);
• a 12.1 percent decline for Hispanic or Latino women (from 67.2 percent to 55.1 percent);
• an 8.5 percent decrease for non-Hispanic Black women (from 73.4 percent to 64.9 percent); and
• a 9.8 percent decline for non-Hispanic White women (from 70.2 percent to 60.4 percent.
For women 40-49 years of age, the researchers also pointed out an 11.9 percent decrease in mammography use from 2008 to 2022 for those without health insurance.
“ … Mammography use did not significantly decline in the overall population over the past (two) decades. However, significant reductions were observed across sociodemographic, health care access, and geographic subgroups of women aged 40 to 49 years following the 2009 USPSTF recommendation,” noted lead study author Syed Mahfuz Al Hasan, Ph.D., who is affiliated with the Division of Public Health Sciences and the Department of Surgery at the Washington University School of Medicine in St. Louis, and colleagues.
For the overall study period, the study authors found declining mammography use among women in their 40s in 46 states including Washington, D.C. although they did acknowledge that these findings were statistically significant in seven states.
Three Key Takeaways
• Screening decline concentrated in women 40–49. Following the 2009 United States Preventive Services Task Force recommendation against routine screening in this age group, mammography use fell by ~8–10 percent from 2008–2022, despite stable overall population screening rates.
• Disparities across race/ethnicity and access. The decline was consistent across all groups — largest in Hispanic (−12.1 percent) and Asian women (−11.5 percent) — and was particularly pronounced among uninsured women (−11.9 percent), highlighting widening access and utilization gaps.
• Potential downstream clinical impact. As reported in JAMA Network Open, reduced screening in younger women may delay diagnosis and shift cancers to more advanced stages, underscoring the need for risk-based screening discussions and alignment with updated guidelines now recommending screening starting at age 40.
“Declines in screening participation may delay diagnosis and shift cancers toward more advanced stages at detection. 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,” emphasized Hasan and colleagues. “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.”
In 2024, the USPSTF issued new breast cancer screening recommendations, including support for biennial mammography screening for women 40-74 years of age.
(Editor’s note: For related content, see “Breast Imaging in Focus: Key Insights from the GEMINI Study on Integrating AI into Mammography Screening,” “New Mammography Study Suggests AI May Predict Breast Cancer Detection in Subsequent Screening” and “Large Mammography Study Shows AI-Aided DBT Bolsters Cancer Detection Without Increasing Recall Rate.”)
In regard to study limitations, the authors acknowledged self-reporting of mammography use in the cohort. The researchers also conceded a lack of direct assessment as to possible correlations between declining mammography screening and advanced breast cancer presentations or mortality, noting that the BRFSS dataset utilized for the cohort doesn’t have outcome data or differentiate between diagnostic and screening mammography.
