Mammography screening and mortality by risk status in the California teachers study

BMC Cancer. 2021 Dec 18;21(1):1341. doi: 10.1186/s12885-021-09071-1.


Background: The debate continues among medical professionals regarding the frequency, starting age, and stopping age for mammography screening. Some experts suggest tailoring recommendations based on individuals' personal breast cancer risk. Previous studies have not compared the impact of annual versus biennial mammography stratified by age group and risk category. The purpose of this study was to examine the relationship between mammography frequency and mortality by age group and risk category in the California Teachers Study.

Methods: Using data from study questionnaires from 93,438 women between the ages of 40 and 85 and linkages to the California Cancer Registry and other indices, overall and breast cancer-specific mortality by mammography frequency were estimated using multivariable Cox proportional hazards models, stratified by age group and risk category at baseline as determined by the Gail breast cancer risk model.

Results: During the follow-up period of 20 years, overall mortality risk was lower in women who had annual or biennial mammography compared to less frequent or no mammography in all age groups. Annual mammography was associated with lower overall mortality risk compared to biennial mammography among women age 50-85. This difference was especially apparent in women age 60-74, regardless of estimated Gail risk category at baseline. Breast cancer-specific mortality was lower among women who had annual mammography compared to biennial or less frequent mammography among women age 60-74, regardless of their baseline risk.

Conclusions: Our findings suggest that at least biennial mammography is beneficial to most women age 40-85 and that annual mammography is more beneficial than biennial mammography to most women age 50-85 in terms of overall mortality.

Keywords: Breast cancer risk; Cohort study; Mammography; Mortality.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Breast / diagnostic imaging
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / mortality*
  • California / epidemiology
  • Early Detection of Cancer / standards
  • Early Detection of Cancer / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Mammography / standards
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Practice Guidelines as Topic
  • Prospective Studies
  • Risk Assessment / statistics & numerical data
  • Time Factors