The Mammography Gap

The headline finding from the research, published in JAMA Network Open, is that overall mammography rates did not collapse. But beneath that reassuring number is a different story, one about which women are quietly disappearing from the data, and why it matters for every woman trying to advocate for her own breast health.

What changed and why

The biggest turning point in this story came in 2009, when the U.S. Preventive Services Task Force (USPSTF) recommended that women in their 40s hold off on routine mammograms and wait until 50. That guidance, combined with confusing, contradictory messages from different medical organizations created real uncertainty for millions of women.

The study found that mammography rates dropped measurably after 2009, especially among younger women. The good news: in 2024, the USPSTF reversed course and now recommends that women begin screening at age 40. But the confusion those 15 years created did not simply disappear.

Who fell through the cracks

The steepest declines did not fall evenly. They landed hardest on women who already face the most barriers to care, according to the JAMA Network Open study: Uninsured women in their 40s. Women without a regular doctor. Lower-income women at every income level below $50,000. Unmarried women and current smokers also saw steady declines. The women most likely to be missed are often the ones least connected to the healthcare system in the first place.

The study also found that mammography rates among Black women remained more stable over this period, while rates among non-Hispanic white, Asian, and uninsured women saw steeper declines. Researchers emphasized the importance of understanding these differences, not to compare communities, but to make sure every woman gets the care she deserves.

Where you live matters too

Your zip code shapes your access to screening. Women in the Western United States, particularly in the Rocky Mountain and Southwest regions, consistently had lower mammography rates than women in the Eastern U.S. States like Vermont and New Mexico saw some of the largest declines over the study period, a reminder that local healthcare infrastructure, rural access to radiology, and Medicaid coverage variation all play a role.

What this means if you have dense breasts

Here is the part that matters most to us at My Density Matters: when mammography rates fall, the women at greatest risk of a missed cancer are women with dense breast tissue. Dense tissue can hide tumors that a standard mammogram cannot see. If fewer women are showing up for screening, and those women are disproportionately uninsured or underserved, the consequences are not abstract. They are lives.
We hear from women every week who did not know they had dense breasts until years after they should have been told. Supplemental screening, an ultrasound, MRI, or contrast-enhanced mammography in addition to a standard mammogram exists precisely for women whose density puts them at higher risk. But you can only advocate for supplemental screening if you show up for the mammogram first.

What you should do right now

There is genuine disagreement among medical organizations about how often to screen. The USPSTF (2024) recommends screening every two years starting at 40. The American College of Radiology and the Society of Breast Imaging recommend annual screening starting at 40. The right frequency for you depends on your personal risk factors, including your breast density.

If you are 40 or older, start with this: find out your breast density. Then bring what you learn to your next doctor’s appointment and ask whether supplemental screening is right for you.

You do not have to navigate this alone. If you have questions we have not answered, reach us at info@mydensitymatters.org. We will help you find the answer or connect you with a partner organization if that is a better fit for your needs.

Source: Al Hasan SM, Bennett DL, Toriola AT. “Trends in Mammography Use Among Women Aged 40 to 74 Years in the US, 2002–2022.” JAMA Network Open. 2026;9(3):e263529.