U.S. Mammogram Rates Fell 4% From 2000 To 2005, Study Says

The proportion of U.S. women age 40 and older who said they have undergone a mammogram in the previous two years declined from 70% to 66% from 2000 to 2005, according to a study to be published in the June 15 issue of the journal Cancer, the Washington Post reports. Nancy Breen and colleagues from the National Cancer Institute and CDC examined data from about 10,000 women who were part of the National Health Interview Survey, an ongoing study of adults conducted by the National Center for Health Statistics that follows health trends.

The data show that the rate of mammograms plateaued in 2000, began to decline in 2003 and continued to decrease through 2005, the final year of the study (Stein, Washington Post, 5/14). A 6.8% decline in the rate among women ages 50 to 64 was the largest of any age group. According to the Los Angeles Times, women in the group are the most likely to benefit from receiving mammograms (Los Angeles Times, 5/14).

Such women also are the most likely to use hormone replacement therapy after the onset of menopause. Use of HRT declined in 2002 after a federal study reported that the treatment increases the risk of breast cancer, heart attack and stroke. Breen and colleagues also found a 6.3% drop in mammography use among more affluent women, the Post reports (Washington Post, 5/14).

Explanations
Clare Bradley, a board member of the American Cancer Society's eastern division, said there are "many things at play" in the decline of mammography rates, including an increasing number of uninsured women, a lack of screening facilities and complacency among women to seek breast cancer screenings as they see a rise in survival rates. Breen said there has been a decline in the number of radiologists who specialize in the field (Ricks, Long Island Newsday, 5/14).














Breen said that another potential reason for the 4% decline in the mammography rate is "women who stop using HRT believe their risk of breast cancer has declined and so they don't feel the need for mammography." She added that women might "not be going to their doctors as often for their hormones, and so are not being told it's time for a mammogram. That's a concern because just because they are not taking HRT does not mean they are not at risk" (Washington Post, 5/14).

Reaction
Although the drop in the mammography rate is "small, this decline may be cause for concern because it signals a change in direction" the researchers wrote (Rubin, USA Today, 5/14). Robert Smith, the ACS's director of cancer screening, said, "A decline in mammography utilization is going to result in a higher rate of cancers diagnosed at an advanced stage," adding, "And that will mean more aggressive treatment, and in some instances, it may mean that women who would have survived if their cancer had been found earlier will not survive" (Dunham, Reuters, 5/14). Carolina Hinestrosa of the National Breast Cancer Coalition said that some "women are beginning to balance the risks and the benefits" of mammography, adding, "If women are making a careful determination and an informed decision after weighing the risks and benefits, I don't necessarily think that's a bad thing" (Washington Post, 5/14). The researchers wrote that the "looming questions are whether the decline in mammography will continue and how it will affect the mortality rates from breast cancer" (Reuters, 5/14).


The abstract of the study is available online.

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