Many women in lung cancer screening remain overdue for mammography. An analysis in the Journal of the American College of Radiology assessed women enrolled in a centralised programme at a U.S. academic medical centre. Mammography completion was below national estimates, while smoking exposure and a personal history of cancer were associated with overdue screening. The findings support closer coordination between lung and breast screening services.
Screening Completion Remains Uneven
The cohort included 2,098 women eligible for breast cancer screening from 4,370 people who underwent lung cancer screening during the study period. Male participants, women older than 75 and women with a history of breast cancer who had undergone bilateral mastectomy were excluded. All participants met the lung screening eligibility criteria applied during the programme.
Breast screening status was established through electronic health record review. Mammography was considered up to date when it had been completed within either 1 year or 2 years of the first low-dose chest CT recorded during the study period. Women without a previous screening mammogram, or whose latest examination fell outside the relevant interval, were classified as overdue.
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Just over half of the eligible women had completed mammography within 1 year of lung screening, while about two-thirds had completed it within 2 years. The 2-year rate was lower than the national estimate cited for screening mammography among eligible women. This gap appeared within a group already participating in a structured cancer screening programme.
Most women were aged between 60 and 69. The cohort included similar proportions of black and white women, and current smoking was common. More than one-third lived in neighbourhoods within the highest deprivation category. Mammography status did not differ significantly across neighbourhood deprivation levels, and no significant differences were found by education or insurance status at the 1-year threshold.
Smoking and Cancer History Shape Overdue Status
Women with greater cumulative tobacco exposure were more likely to be overdue for mammography at the 1-year interval after adjustment for other factors. A personal history of cancer was also associated with overdue status. These relationships remained despite the cohort’s active participation in lung cancer screening, placing some women with substantial cancer-related health needs among those with lower breast screening completion.
Black women were less likely than white women to be overdue at the 1-year interval after adjustment. The difference was not statistically significant in the adjusted analysis using the 2-year threshold. Hispanic ethnicity was associated with overdue mammography at the 2-year interval, but not at the shorter interval.
Chronic obstructive pulmonary disease showed different patterns depending on how the condition was recorded. Women with an electronic health record diagnosis had lower odds of overdue mammography in both adjusted analyses. Self-reported disease was more common among women overdue at 1 year, although the absolute difference was modest and the finding did not form part of the adjusted model.
At the 2-year threshold, current smoking and greater smoking intensity were associated with overdue mammography. Personal cancer history remained associated with delayed screening. The similarity across the two screening intervals indicates that smoking exposure and previous cancer were consistent markers of lower completion in this cohort, while associations involving race and ethnicity varied according to the interval used.
Coordinated Screening Could Address Missed Mammography
Women enrolled in lung cancer screening may offer a practical group for identifying those who are also eligible for breast screening. The proportion of women eligible for mammography is substantially higher within a lung screening cohort than the proportion eligible for lung screening among women attending mammography. This creates a reciprocal opportunity for one screening pathway to support participation in another.
Centralised lung screening programmes may already include navigation processes designed to support attendance and follow-up. Extending those processes to mammography could include coordinated scheduling and navigation within existing workflows. Such an approach would focus on women who have already entered preventive care but remain overdue for another recommended screening service.
The findings nevertheless come from a retrospective analysis at one academic health system. Mammograms completed outside that system may not have appeared in the electronic record, which could have led to underestimation of completion. The single-centre design also limits how readily the results apply to settings without centralised screening programmes.
The total population eligible for lung cancer screening is smaller than the population eligible for breast screening. Improving mammography completion within lung screening services may therefore produce limited population-level gains. However, the low completion observed among women in the programme supports targeted action within a group with substantial smoking exposure and other cancer-related risks. Integrated screening processes may help address missed mammography within established screening pathways.
A substantial proportion of women engaged in lung cancer screening had not completed mammography within the annual or biennial thresholds used. Overdue status was associated most consistently with heavier smoking exposure and a personal history of cancer, while demographic and clinical associations differed by screening interval. Existing lung screening pathways offer a possible setting for identifying women who also need breast screening and coordinating appointments or navigation. The results support targeted integration, while the single-centre design, incomplete capture of external mammograms and smaller lung screening population limit broader conclusions.
Source: Journal of the American College of Radiology
Image Credit: iStock
References:
Maceyko M, Shusted C, Daneshpooy S et al. (2026) Screening Mammography Completion Among Women Enrolled in a Lung Cancer Screening Program. Journal of the American College of Radiology: In Press.
