Trends in Mammography Use Among Women Aged 40 to 74 Years in the US, 2002-2022.

Importance: Understanding how prior policies, systemic factors, and public health events have shaped mammography use among US women is essential for interpreting the 2024 US Preventive Services Task Force (USPSTF) recommendation update and identifying gaps to inform equitable public health strategies. Objective: To analyze mammography use trends in US women aged 40 to 49 and 50 to 74 years from 2002 to 2022 and assess variation by sociodemographic, health care access, behavioral, and geographic factors, including associations with the 2009 USPSTF recommendation and the COVID-19 pandemic. Design, Setting, and Participants: This cross-sectional study used data from the Behavioral Risk Factor Surveillance System biennial cancer screening module (2002-2022). Joinpoint regression with a jump model was used to account for methodological changes in the Behavioral Risk Factor Surveillance System beginning in 2011. Data were analyzed from March to September 2025. Main Outcomes and Measures: The primary outcome was the average biennial percentage change in mammography use from 2002 to 2022, calculated as a weighted average of jump model-estimated biennial changes. Subgroup analyses were conducted by sociodemographic, health care access, behavioral, and geographic factors. Results: Among 2 619 292 US women, mammography use showed a downward trend, with nonsignificant biennial changes of -0.54% (95% CI, -1.25% to 0.16%) for ages 40 to 49 years and -0.16% (95% CI, -0.49% to 0.16%) for ages 50 to 74 years from 2002 to 2022. Declines were significant among young women without health insurance (-1.54%; 95% CI, -2.89% to -0.17%), current smokers (-1.36%; 95% CI, -2.43% to -0.27%), unmarried women (-1.10%; 95% CI, -1.61% to -0.59%), and non-Hispanic White women (-0.58%; 95% CI, -1.09% to -0.07%). Following the 2009 USPSTF recommendation, mammography use decreased significantly among younger non-Hispanic White (-0.88%; 95% CI, -1.59% to -0.16%), Asian (-2.45%; 95% CI, -4.20% to -0.25%), and uninsured (-2.39%; 95% CI, -4.57% to -0.16%) women, with no significant reduction among non-Hispanic Black women (-0.59%; 95% CI, -1.20% to 0.03%). Across both age groups, mammography use was consistently lower in Western than in Eastern states. Conclusions and Relevance: In this cross-sectional study, mammography use did not significantly decline in the overall population; however, significant reductions were observed among non-Hispanic White, Asian, and uninsured women aged 40 to 49 years from 2010 to 2022. These findings highlight the need for clear, risk-based screening communication and targeted strategies to promote guideline-concordant decision-making, particularly among younger women.