Missing your first mammogram increases your risk of dying from breast cancer.

Women who don't have their first mammogram have up to a 40% higher risk of dying from breast cancer, according to a study by the Karolinska Institute in Sweden, published in September in the British Medical Journal (BMJ) . The study followed 432,000 women for 25 years, evaluating their routine preventive measures against cancer.
The survey shows that 32% of participants advised to undergo the screening, either by medical recommendation or because they reached the age for active screening, did not attend their mammogram. "Delays in diagnosis resulting from not undergoing screening have a direct impact on patient survival, especially for those with more aggressive and faster-growing tumor subtypes," comments oncologist Heloisa Veasey Rodrigues, a physician in the Breast Group at Einstein Hospital Israelita.
For most women who missed their first mammogram, the habit of not showing up on time persisted over time. During the 25 years of research, women should have had 10 screenings: those who attended their first scheduled appointment attended an average of 8.74 screenings, while those who missed them attended almost half that number, 4.77 tests.
The 40% higher mortality rate among those who didn't attend was attributed precisely to the lack of preventive measures. This is especially true because, according to the study, the overall incidence of cancer was similar between the groups—7.8% among participants compared to 7.6% among non-participants.
The reason for the high number of deaths was that the tumors diagnosed in those not undergoing standard screening were more advanced, with a third of them discovering their cancer when it was already symptomatic. "Although the incidence is similar, tumors diagnosed outside of screening may have a worse prognosis and, consequently, a lower chance of cure," explains Rodrigues.
Lack of adherence to mammography screenings may reflect risky behavior that combines a number of factors: lack of awareness of the need for prevention, limited access to screenings, and even fear of diagnosis. "There's still a stigma surrounding breast cancer being heavily associated with aggressive treatment and the fact that it reduces quality of life. It's a mistaken view, tied to an old idea that cancer is a difficult-to-treat and incurable disease," says the oncologist.
When to take the exam
The Brazilian Society of Mastology (SBM) recommends that screening begin at age 40 and continue until age 74 with annual exams. To increase screening rates, in September 2025, the Unified Health System (SUS) reduced the bureaucracy for women between 40 and 50 years old, who previously required a family history or express medical recommendation to receive screening in the public health system.
For the Einstein oncologist, including younger women in mammogram queues is a critical concern in combating tumors. This is because those that appear before menopause are often more aggressive. "Especially in Brazil, the occurrence of breast tumors before the age of 50 is more common than in other regions of the world," warns Heloisa Rodrigues.
Mammography campaigns and trucks
International studies such as those conducted by researchers at the Karolinska Institute reinforce that initial participation in breast cancer screening programs has a long-lasting effect on reducing mortality.
To ensure regular follow-up, however, women need to be made aware of the importance of mammography, and public policies need to bring the exam to areas with less access. "It's always important to invest in screening and rapid diagnosis campaigns, such as mammography trucks. When information is available, fear diminishes. It's important to explain that mammography isn't painful, that treatment has evolved, and that there are high cure rates," concludes the oncologist.
Source: Einstein Agency
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