Missing first breast-screening appointment linked to higher mortality, study finds

Women who miss their first breast cancer screening appointment have a 40 per cent higher risk of dying from the disease over the next 25 years, according to a long-term study from Sweden.

The study tracked nearly half a million women who received their first screening invitation between 1991 and 2020 and were followed for up to 25 years. After adjusting for social, economic, reproductive, and health-related factors, researchers found that about 32 per cent did not attend their first mammogram. Those who did not attend were less likely to participate in subsequent screenings and were more likely to be diagnosed at an advanced stage.

Mortality among first-appointment non-attenders was 9.9 deaths per 1,000 women over 25 years, compared with 7 per 1,000 among those who attended. The 25-year rate of breast cancer incidence was similar between groups, indicating that the higher death rate most likely reflects delayed detection rather than greater disease occurrence. In the British Medical Journal, the researchers said first-screening non-participation had a 40 per cent higher mortality risk than participants, persisting over 25 years, and that first mammography screening could be a crucial window for preventing adverse outcomes. An accompanying commentary from US researchers described attendance at the first screening as a long-term investment in breast health and survival.

In the UK, data show that only about 70 per cent of eligible women were up to date with breast screening as of March 2024, leaving a substantial share never receiving a first invitation or returning to screening. England invites women aged 50 to 71 for screening, with the first invitation typically arriving by age 53. Scotland and Wales run programs for women aged 50 to 70. Health charities and NHS advocates say the uptake target of 80 per cent should be pursued to maximize early detection and improve survival.

Breast Cancer Now chief executive Claire Rowney noted that despite the effectiveness of screening, many women still miss the first appointment and are unlikely to attend future invitations. The findings add urgency to efforts to make screening more accessible and to encourage attendance at the initial screening as a potential predictor of long-term outcomes. Public health groups say increasing first-appointment attendance could be a turning point in detecting cancers earlier and saving lives, particularly among groups with historically lower screening uptake.