Fewer Vermont Women Are Getting Regular Mammograms, Researchers Report

A new study by researchers from the University of Vermont Cancer Center (UVMCC) found that mammography screening rates have steadily declined among Vermont women over the past 14 years, with the sharpest decreases occurring among younger women.  

The study was published in Cancer Epidemiology, Biomarkers & Prevention, and includes research from UVMCC members Sarah A. Nowak, Ph.D.; Erika Ziller, Ph.D.; Michelle Sowden, M.D.; and Brian L. Sprague, Ph.D., who is co-leader of UVMCC’s Population Science and Cancer Outcomes research group. By analyzing individual-level screening trends using Vermont's all-payer claims database, the study provides one of the most comprehensive looks to date at how mammography use has changed across generations of women. 

“The decline wasn't limited to a single age group,” says Nowak, the study’s lead author.  “We found evidence of long-term decreases in screening participation across generations of women, even after accounting for disruptions caused by the COVID-19 pandemic.” 

Tracking Screening Trends Across Generations 

Routine screening via mammography is recommended for women beginning at age 40. To understand how screening behavior has changed over time, researchers examined biennial, or every-two-year, mammography screening rates among Vermont women from 2010 through 2023. 

The analysis revealed a long-term decline in screening participation across age groups. Among women ages 40 to 49, biennial mammography screening adherence dropped by 20.7 percentage points during the study period. Among women ages 50 to 74, adherence declined by 6.7 percentage points. 

Researchers also found evidence that screening rates differed by birth cohort – that is, specific years in which people are born. This suggests that women's attitudes toward mammography may be changing from one generation to the next. 

The decline is noteworthy because mammography screening has been credited with helping reduce breast cancer deaths by detecting cancer at earlier, more treatable stages. Even so, breast cancer remains the second-leading cause of cancer death, behind lung cancer.  

Why are screening rates declining in Vermont?  

Researchers say the reasons behind the decline are likely complex and warrant further study. One factor may be changing public perceptions about the benefits and limitations of mammography. While mammography can save lives, screening can lead to false-positive results, additional testing, anxiety, and in some cases overdiagnosis. 

Several other factors could be influencing participation rates. Among them are differences in screening recommendations issued by professional organizations over the years; and broader health care access issues. For example, having a primary care provider is strongly associated with screening adherence, while ongoing primary care workforce shortages in Vermont may contribute to lower screening rates across the state. Insurance coverage and other economic factors may also impact whether women choose to get screened.  

Researchers also noted how the COVID-19 pandemic disrupted preventive health care services nationwide, including routine cancer screenings like mammography. Despite accounting for these disruptions, the overall long-term trend has remained unchanged: fewer Vermont women are receiving regular mammograms.  

Looking Ahead 

The findings underscore a need for personalized approaches to breast cancer screening. Researchers are increasingly using individualized risk prediction models that consider factors such as dense breast tissue, age, and family history to identify women who may benefit from more intensive screening, such as ultrasound.  

One of these personalized approaches is a risk assessment tool developed by Sprague and his colleagues from the Breast Cancer Screening Consortium, which is based on data from more than a million women, including Vermonters.  Available as a free phone app, the tool helps users calculate their 5-year risk of breast cancer and 6-year risk of a late-stage breast cancer by considering factors such as age, race/ethnicity, family history, and breast density, and screening frequency (annual vs. biennial). 

The study’s authors conclude that sustaining post-pandemic screening participation will also be critical to reversing Vermont's long-term decline in mammography use. 

“These findings highlight the importance of understanding how women navigate screening decisions in a rapidly changing health-care environment,” says Sprague. “That knowledge can help inform policies and programs that support early detection and equitable access to care – all critical factors for improving Vermont’s mammography screening rates across the board.” 

Read the study: Individual-Level Trends in Mammography Screening over 14 years: Results from an All-Payer Statewide Claims Database 

If you are 40 years or older, talk to your primary care provider about breast cancer screening. To learn more about your personal risk for developing breast cancer, use the Breast Cancer Screening Consortium’s risk assessment tools.