Characteristics associated with women undergoing their first mammography screening at a younger age

Breast cancer is the most commonly diagnosed cancer and a leading cause of cancer death among women. Kuwait has among the highest age-standardized incidence in the Gulf, yet mammography uptake remains low. The 2024 USPSTF recommends routine screening from age 40 for average-risk women. To identify characteristics associated with undergoing first-time mammography at ages 40-49 versus ≥50 in Kuwait. Cross-sectional analysis of 5,242 asymptomatic Kuwaiti women aged ≥40 with no prior screening in the Kuwait National Mammography Screening Program, 2014-2019. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% CIs. Overall, 65.0% had their first screen at 40-49. Younger screening increased over time (per-year aOR 1.10, 95% CI 1.06-1.14; Cuzick z = 4.56, p < 0.001). Higher odds were observed with university or postgraduate education versus illiterate to secondary (aOR 4.53, 3.71-5.53; p < 0.001), parity 3-5 versus none (2.66, 1.85-3.82; p < 0.001), clinical breast examination (1.39, 1.11-1.74; p = 0.004), hormone replacement therapy use (1.69, 1.28-2.23; p < 0.001), and citing social media as the main information source (2.58, 1.28-5.19; p = 0.008; n = 94, 1.8%). Lower odds were seen for overweight (0.67, 0.53-0.85; p = 0.001) and obesity (0.53, 0.42-0.66; p < 0.001) versus normal BMI, hysterectomy (0.51, 0.34-0.76; p = 0.001), and longer breastfeeding (≥24 months versus never to <1 month: 0.41, 0.30-0.57; p < 0.001). Earlier first screening was associated with higher education, greater parity, clinical contact, hormone therapy use, and digital information sources, and was less likely with higher BMI, hysterectomy, and prolonged breastfeeding. Targeted, culturally tailored outreach to women with lower education or higher BMI, along with evaluated digital strategies, may promote earlier participation. Prospective follow-up is needed to determine whether earlier first screening leads to down-staging and improved outcomes.