Fewer women who have survived breast cancer are returning for their annual mammogram. That’s according to new research published this month in the Journal of the National Comprehensive Cancer Network.

The study suggests that the rate of mammography use by breast cancer survivors has been steadily declining since 2009, particularly among younger survivors.

It’s a concerning trend, according to Dr. Kimberly Funaro, who works in breast imaging at Moffitt Cancer Center.

“It’s important to remember that women with a personal history of breast cancer can still develop a subsequent and new breast cancer,” Funaro said. “Additionally, these patients may develop a recurrent cancer. Early detection is always key.”

Researchers reviewed a nationwide commercial claims database to review annual mammography rates in patients aged 40 to 64 with a personal history of breast cancer. Approximately 74% of survivors between ages 50 and 64 were getting annual mammograms from 2004-2009, but that rate slipped to 67% by 2016. For the 40- to 49-year-old group, annual mammography rates held steady at 70% from 2004-2009 before dropping to 57% by 2016.

"The goal of mammography, including women with a personal history of breast cancer, is to detect breast cancer early while it is still treatable and less likely to have undergone distant spread."

- Dr. Kimberly Funaro

“The goal of mammography, including women with a personal history of breast cancer, is to detect breast cancer early while it is still treatable and less likely to have undergone distant spread,” Funaro said. “Every patient that receives a mammogram at Moffitt, whether they are a former breast cancer patient or not, receives a letter notifying them of their results in plain language and follow up recommendations.”

That “lay letter,” as it’s called, is required by law to be sent to all patients undergoing mammography. Even if the result is negative, Funaro says the letter includes a recommendation for continued annual mammography.

According to the study’s results, annual mammography rates declined by approximately 1.5% per year from 2009-2016 overall, but that rate of decline jumped to 2.8% for survivors 40- to 49-years-old. The study authors note this is particularly concerning given that younger patients are more likely to develop aggressive tumors and also have a longer remaining life expectancy.

The results were examined by recency of surgery or primary care visit, neighborhood racial and socioeconomic demographics, geographic region and deductible costs. The data were not conclusive on which specific factors are driving the decline.

“This study highlights the underutilization of mammography not just in a screening population, but in women with a prior history of breast cancer,” Funaro said. “It is concerning that these drops in annual mammography are observed in women across multiple demographic factors, including those with recent engagement in the healthcare system.”

Funaro specifically points out that the most notable decline in mammography participation comes in younger survivors (age 40-49) who are more likely to have aggressive tumors and more life expectancy left to lose.

“More studies are needed to better understand what is driving these declines,” Funaro said. “Ultimately, we need to find ways to reduce barriers to mammography and prevent these missed opportunities for potentially life-saving screening.”