Most women are getting their first mammogram screenings for breast cancer at the recommended age of 40, but few are returning for yearly screening, a study released Monday suggests.

Moreover, researchers found, some groups of women tend to put off their first mammogram for years. In their study of women receiving mammograms at one large medical center, patients who lacked private health insurance or did not speak English typically had their first screening six to nine years after the recommended age.

In addition, black and Hispanic women tended to start mammography later than white women, and obese women sought screening later than thinner women, according to findings published Monday in the online edition of the journal Cancer.

Studies show that mammograms, while imperfect, can save women’s lives by catching early-stage tumors, and the American Cancer Society and other medical organizations recommend that women begin having yearly mammograms at age 40. Whether most women are actually starting at this age has been unclear.

The new findings can be viewed as both good and bad news, according to study co-author Dr. James S. Michaelson of Massachusetts General Hospital in Boston.

“It’s very encouraging that most women are beginning (mammography) on time,” he told Reuters Health.

On the other hand, Michaelson said, it’s concerning that so many are not returning for repeat screening in a timely manner.

Overall, the study of more than 72,400 women, who all received mammograms at Massachusetts General, found that just 16 percent of those who’d had a mammogram in 1996 also had five mammograms over the next five years. More than 35 percent had only one or two screenings during that period.

The fact that most women were not having yearly mammograms reflects a failure in the healthcare system, according to Michaelson. “It’s the system that’s failing to encourage them to come back,” he said.

Among the women in the study, 940 had their first screening between 2000 and 2002. Sixty percent of these women were younger than 41 at this initial screening, Michaelson and his colleagues found, and nearly 90 percent were younger than 50.

Black and Hispanic women typically received their first mammogram at age 41, about a year later than white women. And obese women began screening almost two years later than thinner women.

But it was non-English speakers and women who either were on Medicaid or paid for their own mammograms who put off their first screening the longest. Women in each group tended to get their first mammogram in their late 40s, while those who neither spoke English nor had private health insurance typically began around age 55, 15 years past the recommended age.

“We need to do more to reach out to these groups,” Michaelson said.

Some ways to start, he said, are by producing public service announcements and ads on mammography in various languages, and by doing a better job of letting low-income women know about low-cost or free mammography programs.

SOURCE: Cancer, online edition September 13, print edition October 15, 2004.