ScreEning
after
survival
How many mammograMs
is too many?
SBR Project ID
#HM01
Date of project
April 2014 – October 2025
Location
United Kingdom
Type of project
Phase III Clinical trial
Categories
This project is sponsored by:
After breast cancer treatment, women usually have regular mammogramsA mammogram is an X-ray of the breast used to detect early signs of breast cancer and other abnormalities that may be too small to feel. Each breast is compressed between two plates while images are taken from different angles. to catch any cancer that might come back or new cancers that might develop. But there isn’t much evidence that shows how often these follow-up mammograms should happen – different countries and hospitals do it differently. A new study, Mammo-50, hopes to shed some light on the situation.
5,235
Women
took part in the study
114
NHS hospitals
were involved
6
Years
of follow-up study
AIMS
What we want to know
For breast cancer survivors over 50 who have been cancer-free for three years, most UK hospitals offer annual mammograms, but there is a lack of evidence on whether this is necessary.
Can these women safely have mammograms less frequently than once per year without affecting their survival?
Or to put it another way: Are these women more likely to survive if they have an annual mammogram?
Why are we only looking at women over 50?
Here’s something counterintuitive: the reappearance of breast cancer in women is actually at a lower rate in older women than in those under 40. Older women are also more likely to survive after diagnosis. The statistics are striking:
Recurrence rates by age
Women aged 36-40
Women aged 41-50
Women aged 51-60
Women aged over 60
This suggests that the surveillance frequency in some older patients who have been treated for breast cancer could be safely reduced.
Importance
Why do we want to know?
Earlier diagnosis and improved treatments mean more breast cancer survivors living longer lives. Keeping track of all of them with regular mammograms takes a lot of healthcare resources.
The UK’s National Health Service (NHS) sees hundreds of thousands of breast cancer survivors who need follow-up care. If less frequent scanning proves just as effective, resources could be redirected to where they’re needed most, potentially reducing waiting times for everyone.
But it is vital to consider the patient’s well-being.
The Testing Anxiety
Some women feel anxious about having a mammogram. Let’s face it, having your breasts squeezed between two plates isn’t fun. Also, more frequent mammograms mean higher chances of overdiagnosis and false positives – especially in older women who’ve had cancer before. Those false alarms can bring a cascade of anxiety and stress.
The Waiting Anxiety
On the flip side, patients understandably have a fear of recurrence, which can lead to a heightened risk of depression, so some women may feel anxious if they don’t have an annual check.
The Mammo-50 study explored whether less frequent surveillance could maintain safety while reducing the psychological burden of constant monitoring.
Project
So we set up a study
The Mammo-50 study was designed to find out if less frequent mammograms in women 50 and older who had been cancer-free for three years could be just as safe while also reducing worry for patients and costs for healthcare systems.
Between April 2014 and September 2018, 5,235 women who had undergone curative surgery to remove their cancer, who were free of recurrence three years post-surgery, and were 50 years or older at the time of diagnosis, were randomly assigned to two groups:
Annual Mammograms
2,618 women
Yearly mammograms
Less frequent
2,617 women
2-yearly (or 3-yearly after mastectomy)
Why less frequent after mastectomy?
A mastectomy removes the breast tissue, so local recurrence is unlikely. These patients therefore have a similar risk to the general population who have not been previously diagnosed with breast cancer.
What we measured
Breast cancer-specific survival
Cost-effectiveness
What’s this?
This includes hospital costs and costs of surveillance mammograms, patients’ time off work, incapacity benefits, travel and parking related to health appointments, and other health-related expenses.
Overall survival
Recurrence-free interval
Number of referrals back to the hospital system
Quality of Life Assessment
What’s this?
Participants filled in questionnaire booklets for 6 years after entering the trial (9 years after their surgery). The questionnaires asked about how they felt about the follow-up methods and procedures, and their worries and concerns.
This is called a “non-inferiority trial”, meaning we wanted to prove that less frequent screening was just as safe as annual screening. No worse outcomes, no increased risk.
Timeline
The long journey
Research takes time. Lots of it.
Recruitment begins
First woman joins the study.
Recruitment complete
Final woman joins the study.
Follow-up ends
Years of tracking, recording, and supporting. Nearly 25,000 mammograms performed.
First results published
Survival rates published in the journal, The Lancet.
Quality of life results published
Analysis of quality-of-life questionnaires published in the journal, Health and Quality of Life Outcomes.
Cost-effectiveness results published
Results published in the British Journal of Cancer.
Results
What we found
Less frequent mammography was just as safe as annual screening.
The two groups had similar:
5-year breast cancer-specific survival
Click to reveal key numbers
5-year breast cancer-specific survival
98.1%
in the annual
mammogram group
98.3%
in the less
frequent group
5-year recurrence-free intervals
Click to reveal key numbers
5-year recurrence-free interval
94.1%
in the annual
mammogram group
94.5%
in the less
frequent group
Overall survival at 5 years
Click to reveal key numbers
Overall survival at 5 years
94.7%
in the annual
mammogram group
94.5%
in the less
frequent group
Over 6 years, less frequent mammograms led to estimated cost savings for the NHS of:
£185.87 million
The quality of life surprise
Over 80% of participants took part in the quality-of-life study and completed the questionnaires. That’s remarkable engagement.
The study found that mammogram frequency did not affect the quality of life in women aged 50 years or older and 3 years post-breast cancer diagnosis.
Many women reported that their worries about their previous breast cancer and possible recurrence had receded into the background. They were dealing with issues such as supporting their loved ones as they move into older age and the side effects of cancer treatment.
However, the study did demonstrate that 6-8% of women had high levels of distress resulting from persistent unmet needs following their diagnosis or treatment of breast cancer.
This means if we’re going to reduce screening frequency, we need better systems to help women navigate life after diagnosis.
Questions
Unexplored questions
Like all good research, this study answered some questions and raised others. Explore the topics below to see what we still need to know.
Every woman is an individual with a different set of conditions. Trials always have to set parameters – that naturally means excluding certain participants and limiting what we can measure. Further clinical trials focused on specific groups are necessary to build a complete picture.
IMPACT
What’s happened
New guidelines released
The Royal College of Radiologists released new guidelines based on the evidence of the Mammo-50 trial results in October 2025.
Survival results published
Full paper published in The Lancet in February 2025
Quality of life results published
Full paper published in the journal, Health and Quality of Life Outcomes, in July 2025
Cost-effectiveness results published
Full paper published in the British Journal of Cancer in November 2025
Future
Hopes for the future
Our findings can help doctors create better guidelines for the millions of breast cancer survivors around the world.
🎯 Personalised Care
Many cancers in the Mammo-50 study weren’t caught by scheduled mammograms – they showed up between scans or through symptoms. This highlights the need for a more personalised approach. In the future, we could develop an online tool – similar to tools already used to assess cancer treatments – that calculates each woman’s individual surveillance needs based on her surgery type, tumour characteristics, age, and personal circumstances. Rather than one-size-fits-all schedules, women and their doctors could make informed decisions together about what’s right for them.
team
Who are we?
Our lead investigators
Professor Janet Dunn
Lead Investigator
University of Warwick, UK
Mr Peter Donnelly
Surgical Lead Investigator
Torbay and South Devon NHS Foundation Trust, UK
- Airedale General Hospital | Claire Murphy, Ali Nejim
- Alexandra Hospital | Mark Churn
- Antrim Hospital | Brendan McFall, Michael Whiteside
- Barnet Hospital | Glenda Kaplan, Elli Papantoniou
- Barnsley Hospital | Julia Dicks
- Basildon University Hospital | Thaj Rehman
- Basingstoke and North Hampshire Hospital | Kevin Harris
- Bedford Hospital | Habib Charfare
- Belfast Hospital | Stuart McIntosh
- Borders General Hospital | Carolyn Bedi
- Bronglais General Hospital | Saira Khawaja
- Broomfield Hospital | Sanjay Kavia
- Castle Hill Hospital | Peter Kneeshaw
- Charing Cross Hospital | Deborah Cunningham
- Churchill Hospital | Bernadette Lavery, Nicola Levitt
- City Hospital | Fiona Hoar
- Clatterbridge Hospital | Raman Vinayagam
- Craigavon Area Hospital | Peter Mallon, Helen Mathers, Reem Salman, Norah Scally
- Cumberland Infirmary | Lekha Potti
- Diana Princess of Wales Hospital | Kathy Dent
- Doncaster Royal Infirmary | Lynda Wyld
- Dorset County Hospital | Thomas Marsh
- Ealing Hospital | Sylvie Flais, Anwen Newland
- East Surrey Hospital | Shamaela Waheed
- Forth Valley Royal Hospital | Subodh Seth
- Frimley Park Hospital | Isabella Karat
- George Eliot Hospital | Yogesh Jain, Kishore Makam, Natarajan Vaithilingham
- Grantham and District Hospital | Jibril A Jibril
- Great Western Hospital | Nathan Coombs
- Harrogate District Hospital | Caroline Costello
- Hereford County Hospital | Kaustuv Das
- Hillingdon Hospital | Charlotte Westbury
- Hinchingbrooke Hospital | Cheryl Palmer
- Kettering General Hospital | Gavin Wilson
- Kidderminster Hospital | Mark Churn
- King Edward VII | Ruth Davis
- King’s Mill Hospital | Lubna Noor, Terri-Ann Sewell
- Leighton Hospital | Vanessa Pope
- Lincoln County Hospital | Jibril A Jibril
- Llandough Hospital | Philippa Young
- Luton and Dunstable Hospital | Katharine Kirkpatrick
- Macclesfield District General Hospital | Jalal Kokan
- Maidstone Hospital | Jenny Weeks
- Manor Hospital, Walsall | Betty Tabe-Ojong, Lisa Richardson, Lynda Wagstaff
- Medway Maritime Hospital | Asma Javed, Rosemary Toye
- Milton Keynes Hospital | Sheeba Taneja
- Musgrove Park Hospital | Amanda Thorne
- New Cross Hospital | Raghavan Vidya
- Ninewells Hospital | Andrew Evans, Jane Macaskill
- Norfolk & Norwich University Hospital | Samyukta Boddu, Simon Girling
- North Manchester General Hospital | Maria Bramley, Nabila Nasir
- North Tyneside General Hospital | Mike Carr, Amanda Walshe
- Northwick Park | Sabina Rashid, Robert Reichert
- Nottingham City Hospital | Eleanor Cornford, Lisa Hamilton
- Peterborough City Hospital | Steven Goh
- Pilgrim Hospital | Jibril A Jibril
- Pinderfields Hospital | Amanda Coates
- Prince Philip Hospital | Saira Khawaja
- Princess Royal University Hospital (London) | Abdul Kasem, Prakash Sinha, Nicola Griffiths
- Queen Elizabeth Hospital Birmingham | Salena Bains
- Queen Elizabeth Hospital Gateshead | Sally Athey, Sheetal Sharma
- Queen Elizabeth Hospital Woolwich | Kislaya Thakur
- Queen’s Hospital (Burton) | Susan Williams-Jones
- Queen’s Hospital, Romford | Mary Quigley
- Rotherham Hospital | Inder Kumar, Tahir Masudi
- Royal Albert Edward Infirmary | Amar Deshpande
- Royal Berkshire Hospital | Joss Adams
- Royal Bolton Hospital | Sheila Grewal, Nida Rehman, Donna-Marie Rigby
- Royal Cornwall Hospital | Miklos Barta
- Royal Derby Hospital | Mark Bagnall
- Royal Devon & Exeter Hospital | Douglas Ferguson
- Royal Free Hospital | Cathy Batista, Sarah Hamilton, Liewah Johnson, Jennifer Osei Bobie
- Royal Hallamshire Hospital | Olga Hatsiopoulou
- Royal Hampshire County Hospital | Kevin Harris
- Royal Lancaster Infirmary | Rishi Parmeshwar
- Royal Liverpool University Hospital | Julia Henderson, Chris Holcombe
- Royal Oldham Hospital | Maria Bramley, Lyndsay Scarratt
- Royal Shrewsbury Hospital | Tamoor Usman
- Royal Stoke University Hospital | Liz Gunning
- Royal Surrey County Hospital | Julie Cooke, Caroline Taylor
- Royal United Hospital Bath | Helen Burt, Georgina Devenish
- Royal Victoria Infirmary | Nerys Forester
- Russells Hall Hospital | Velin Voynov
- Salford Royal Hospital | Seema Datta
- Salisbury District Hospital | Victoria Brown
- Scarborough Hospital | Julie Cooper, Caroline Costello
- Scunthorpe General Hospital | Kathy Dent, Jenny Smith
- Solihull Hospital | Medy Tsalic
- Southend Hospital | Asha Eleti
- Southmead Hospital | Anjum Mahatma, Zenon Rayter
- St Albans City Hospital | Stephanie Sutherland
- St George’s Hospital | Laura Assersohn, Muireann Kelleher
- St Helens Hospital | Riccardo Audisio, Tamara Kiernan
- St James’ University Hospital | Raj Achuthan
- St Mary’s Hospital, Isle of Wight | Alison Brown, Jennifer Marshall
- St Mary’s Hospital London | Deborah Alison Cunningham
- Stepping Hill Hospital | Helen Haydock, Sheila Hodgkinson, Mohammad Sharif, Wiesia Woodyatt
- Sunderland Royal Hospital | Julie Cox, Melanie Robertson
- Tameside General Hospital | Caroline Scott
- Torbay Hospital | Fareed Memon
- University Hospital Coventry | Muthyala Sreenivas
- University Hospital North Durham | Mansoor Yousuf
- Wansbeck General Hospital | Amanda Walshe
- Warwick Hospital | Lucie Jones
- West Cumberland Hospital | Lekha Potti
- West Middlesex University Hospital | Pippa Riddle
- Weston General Hospital | Rachel Ainsworth, Thomas Wells, Oliver Young
- Whittington Hospital | Emma Spurrell
- Withybush General Hospital | Fawwaz Arikat, William Maxwell
- Worcester Royal Hospital | Mark Churn
- Wycombe Hospital | Giles Cunnick
- Wythenshawe Hospital | Emma Hall, Anthony Maxwell
- Yeovil District Hospital | Bijan Ansari, Caroline Osborne
- York Hospital | Julie Cooper, Caroline Costello, Marijke Zuijdwijk
We couldn’t have done this without all the participants in this study, the investigators, and all the staff involved. We thank everyone for their support.
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