Individual-level trends in mammography screening over 14 years: results from an all-payer statewide claims database

BACKGROUND: Our objective was to characterize individual-level screening patterns during a fourteen-year period spanning changing breast cancer screening guidelines and the COVID-19 pandemic. METHODS: We conducted a retrospective analysis of mammography screening in women ages 40 and older using 2010-2023 data from the Vermont Health Care Uniform Reporting and Evaluation System, a statewide all-payer insurance claims database. RESULTS: Biennial mammography screening adherence declined between 2010-2023 by 20.7 and 6.7 percentage points for women aged 40-49 and 50-74 years, respectively. Younger birth cohorts consistently had lower screening rates at any given age compared to older cohorts. Cohorts under age 50 during the COVID-19 pandemic have had the largest post-pandemic recoveries, with post-pandemic screening rates exceeding pre-pandemic screening adherence. CONCLUSIONS: While mammography screening rates have been declining both between and within birth-cohorts, pandemic disruptions have narrowed the gaps resulting from these trends. IMPACT: Sustaining post-pandemic screening momentum may be critical to reversing long-term declines in adherence.