(CTN News) – Across the country, fewer women are getting screened for breast cancer regularly since 2009 guidelines changed. This is true even for women in the 50- to 74-year-old age group, for whom a mammogram is recommended every two years or annually.
Researchers at University of Vermont Larner College of Medicine reported that the mortality rate for that age group decreased by 4.5 percentage points across all 50 states between 2009 and 2018. As a result, around 2.4 million fewer patients in the targeted age group will not receive regular screenings.
A decrease in screenings across all ages was seen in Vermont, the second largest in the country.
Researchers are publishing their research in the American Journal of Preventive Medicine based on a statistical analysis of CDC behavioral survey responses at the national and state levels. Based on the answers provided by respondents who identified themselves as women, we conducted the analysis.
A similar pattern was found across the country by the authors, including Sarah Nowak and Brian Sprague of UVM. For women ages 75 and older, for whom mammograms are no longer recommended, the rate of regular screening fell by an average of 13.5 percentage points in every state.
Most states also saw a drop in the rate of women 40 to 49, for whom the recommendation is based on personal preference and family history.
I expected that to happen. Researchers have found that those declines are also associated with a slightly lower drop in screening among women age 50 to 74, the age when mammograms may be a factor in reducing breast cancer death.
Nowak, a pathology and laboratory medicine assistant professor, understands the correlation. She previously found that people are more likely to get mammograms if they hear from people in their social circle who have detected early stage breast cancer this way.
“Knowing other people who have been diagnosed early because of screening is a strong motivator for getting screened yourself,” Nowak said. “Women have friends and family of all ages.”
After a guideline change like that, Nowak noted, there may be a need to extend outreach to a targeted group.
Women ages 50 to 74 were less likely to receive biennial screenings in Vermont. According to Nowak, Kansas had the largest decline.
As a result, Vermonters in that age group have been screened less regularly for breast cancer since 2009.
He reported in a prior study that 65.4% of Vermont women were getting mammograms at least every two years based on reports to the Vermont Breast Cancer Surveillance System, which he heads. As early as 2011, data showed a decline in screenings in that age group.
The 2009 guideline change by the U.S. Primary Care Task Force was based on a variety of new research findings. Part of the reason was that some breast cancers are relatively inactive and may take decades to progress.
Breast cancer deaths may increase if the decline in regular mammograms among the recommended age group results in a higher rate of late-stage detection or higher mortality.
It takes around a decade for screening to show its benefits, Nowak said. “So it simply takes time to develop the statistical power to observe those kinds of effects in the population.”
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