Skipping First Mammogram Screening Increases Long-Term Breast Cancer Mortality Risk

Women who do not participate in their first eligible mammogram screening have a long-term risk for dying from breast cancer, according to a study published online Sept. 24 in The BMJ.

Ziyan Ma, from the Karolinska Institutet in Stockholm, and colleagues assessed whether women who did not attend their first mammography screening invitation have a long-term risk for poor screening adherence and breast cancer outcomes. The analysis included 432,775 women who received invitations to the Swedish Mammography Screening Programme (1991 to 2020) and were initially invited at either 40 or 50 years of age.

The researchers found that among women invited to their first mammography screening, 32.1 percent did not participate. Nonparticipants were persistently less likely to attend subsequent screenings and were more likely to have a diagnosis of symptom-detected, advanced-stage breast cancer. Nonparticipants had a higher likelihood of stage III (odds ratio [OR], 1.53) and stage IV cancer (OR, 3.61) compared with first-screening participants. Additionally, nonparticipation at first screening was also associated with significantly higher breast cancer mortality, with a 25-year cumulative mortality of 9.9 per 1,000 versus 7.0 per 1,000 for participants (adjusted hazard ratio, 1.40). However, 25-year breast cancer incidence was similar for the groups (7.8 percent in participants versus 7.6 percent in nonparticipants), suggesting that the higher mortality among first-screening nonparticipants likely reflects delayed detection.

“Targeted interventions are warranted to boost adherence to mammography screening and decrease the mortality risk for those who did not participate in the first screening,” the authors write.

Abstract/Full Text

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