Use of surveillance mammography among breast cancer survivors has decreased in recent years, according to a large study published in JNCCN.

The study, which included more than 140,000 breast cancer survivors, showed that annual mammography rates declined from 74.1% in 2004 to 67.1% in 2016.

Declining use was observed across multiple health care and demographic factors, including for patients who had recent engagement with the health care system. The most notable declines were in patients aged 40 to 49 years, according to researchers.

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The study included 141,672 breast cancer survivors in the United States who had commercial health insurance plans. The patients were 40 to 64 years of age at baseline.

The researchers evaluated overall and temporal trends in annual surveillance mammography from 2004 through 2016. Overall, rates of surveillance mammography were stable from 2004 to 2009, with an annual percent change of 0.1%.

However, mammography rates declined 1.5% annually from 2009 to 2016. For patients aged 40 to 49 years, rates declined 2.8% annually after 2009. For patients aged 50 to 64 years, rates declined 1.4% annually after 2009.

During the study period, 49% to 53% of patients visited a surgeon or oncologist. According to researchers, this suggests the decline in mammography screening does not reflect decreased engagement with oncology services overall.

Among patients who had a recent visit with a surgeon, oncologist, or primary care physician, screening surveillance declined by approximately 1.6% to 1.7% annually from 2009 on. The driving forces behind this trend are unclear.

“Whether these declines could potentially reflect changes in ordering patterns among providers is unclear and warrants further investigation,” the researchers wrote.

Trends by neighborhood-level poverty mirrored the trends in the overall cohort. However, that was not the case with mammography utilization by region. For example, in 2016, mammography rates ranged from 72.2% in the Northeast to 63.3% in the West.

For patients with low deductibles ($0–$500), mammography surveillance decreased over the entire study period, with a more pronounced decline beginning in 2011 (annual percent change, -2.1%). Conversely, there was no change for patients with higher deductibles.

The researchers noted that this study is limited because it only included commercially insured patients. Future studies should evaluate surveillance mammography in other breast cancer survivors to better understand the overall trends in the United States.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Lowry KP, Callaway KA, Lee JM, et al. Trends in annual surveillance mammography participation among breast cancer survivors from 2004 to 2016. J Natl Compr Canc Netw. 2022;20(4):379-386.e9. doi:10.6004/jnccn.2021.7081