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Fewer Women Getting Mammograms

Decline May Lead to More Late-Stage Cancers
By
WebMD Health News
Reviewed by Louise Chang, MD

May 14, 2007 -- Fewer American women are getting mammograms, with usage rates dropping the most among those who have traditionally been most likely to be screened for breast cancer.

After rising steadily during the 1990s, mammography screening rates leveled off after 2000 and began to decline about 2003, according to a new report from the National Cancer Institute.

Between 2000 and 2005, usage dropped by roughly 7% among women between the ages of 50 to 64 and 4% among women over 65.

The decline has coincided with a dramatic drop in breast cancer cases, leading to concern that some of the observed decline in incidence may be due to less screening.

If that is the case, an increase in breast cancers detected in their later, less-treatable stages can be expected within the next few years, says NCI economist Nancy Breen, PhD, one of the study researchers.

“We can’t say that this is what we will see yet, but we will be watching very carefully," Breen tells WebMD.

1 in 3 Women Aren’t Screened

The American Cancer Society recommends annual mammogram screenings for average-risk women aged 40 and older, while NCI guidelines call for screening every one to two years for women aged 40 and older.

Between 1987 and 2000, mammography screening rates jumped from 39% to 70% among eligible women 40 and over.

The new report, taken from a nationally representative survey of health trends, shows that 66% of eligible women were screened in 2005.

Breen says the change in direction is cause for concern but not yet cause for alarm.

“This is a heads up, but not a calamity at this point because the drop is pretty small,” she says. “We need to have a better understanding of the causes of the decline so that we can start to design interventions to address those causes.”

Access and Attitude

There is growing concern that women may have less access to mammography screening than they have had in the past because of a decline in mammography centers and radiologists specializing in breast cancer screening and an increase in the number of women in the U.S. who are uninsured or underinsured.

“When co-pays go up, or you lose your health insurance, or the health center you have gone to in the past stops performing mammograms, all of these things can have the effect of eroding the will to screen,” American Cancer Society director of screening Robert Smith, PhD, tells WebMD.

Though declining access is a major concern, it did not appear to be the only cause of the most recent drop in mammography usage.

Some of the sharpest declines were seen among women with the highest family incomes, those with regular access to medical care, and those with both public and private health insurance.

Breen says reports questioning the value of regular breast cancer screening may have had an impact on usage, as has the news that breast cancer incidence is dropping.

“There may be a mistaken belief that their personal risk is lower,” she says. “The main message is we cannot assume that because women have been screened in the past that they will continue to get screened.”

Smith adds that getting women to understand the importance of regular screening is among the biggest challenges facing organizations like the ACS and the NCI.

“Women need to remember that the value of mammography is achieved through regular screening,” he says.

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