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Mammography screening allows for the early detection of breast cancer, which may help reduce mortality from breast cancer, especially among women aged 50 to 69 years.
For women between the ages of 50 and 69, there is solid evidence that screening may lower this risk by up to 30 percent. For women in their 40s, the risk may be reduced by about 17 percent. For women aged 70 and older, mammography may be helpful, although firm evidence is lacking.
Percentage of women aged 40 and older, by racial/ethnic, geographic, and low-income groups, who reported having had a mammogram within the past two years.
In 2010, 66 percent of women aged 40 and older had a mammogram within the past two years, a statistically significant drop from 70 percent (1998–2003). Among racial/ethnic groups, 64 percent of Hispanics (down from 65 percent in 2003), 66 percent of blacks (down from 70 percent in 2003), and 68 percent of whites (down from 70 percent in 2003) had a mammogram within the past two years, but these drops were not statistically significant. Among Asian women interviewed in California, mammography rose to 77 percent in 2009 compared to 74 percent in 2003 and again in 2005. In terms of the social determinants of health, between 1998 and 2010, mammography rates were consistently lower for women living in households with incomes at less than 200 percent of the federal poverty level. There was a consistent education gradient, with women less who had earned than a high school diploma least likely to report a Pap test, women with a high school diploma in the middle, and women with more than a high school education most likely to report being screened.
Healthy People 2010 targets were to increase to 70 percent the proportion of women aged 40 and older who have had a mammogram within the past two years. This target was met in 2003, but the rate dropped to 67 percent, below the target, in 2005 and remained there through 2010.
New Healthy People 2020 targets are limited to women ages 50–74. The 2008 baseline for this age group of women was 74 percent. Healthy People calls for a 10 percent improvement to 81 percent in 2020.
Women who are immigrants and those with lower incomes, with less education, without insurance, and lacking a usual health care provider are less likely to get screening mammograms.
Cost and knowledge barriers, including lack of insurance and lack of provider recommendations for regular mammograms, need to be removed.
For women to benefit from mammography, regular screening is needed. Although millions of women have had at least one screening mammogram, many women still have not. Even among those women who have had a recent screening mammogram, many do not have them on a regular basis. In November 2009, the USPSTF modified their recommendations for mammography screening for specific age groups. For women aged 50 to 74 years, biennial mammography screening was recommended—the previous recommendation was for women aged 40 to 69. Evidence for the decision to start regular, biennial mammography screening before the age of 50 showed more harms and smaller benefits for this age group than for older women; therefore, it was recommended that this should be a decision for individual patients and their physicians to make. For women 75 years or older, the USPSTF concluded that the current evidence is insufficient to make a recommendation.
Different organizations have generated different guidelines. To see guidelines issued by the U.S. Preventive Services Task Force and others, go to http://www.ahrq.gov/clinic/USpstfix.htm. The Guide to Community Preventive Services, http://www.thecommunityguide.org/index.html , is a source of information about evidence-based approaches for enhancing cancer screening.