One would think that a woman who survived breast cancer would be extra vigilant about screening for recurrence, but new research shows that many survivors are not seeking annual mammograms.

Researchers from the University of Massachusetts Medical School have discovered that the more time that passes after a woman beats breast cancer, the less likely she is to get her annual mammogram. Since breast cancer survivors have a greatly increased risk of having a recurrence of cancer, annual mammograms are essential to catch a problem early.

"It's an alarming trend," said study author Dr. Chyke A. Doubeni, assistant professor of family medicine and community health at the University of Massachusetts Medical School.

In a study that included almost 800 breast cancer survivors over the age of 55, Doubeni and colleagues found that as many as 80 percent were screened for recurrence in their first year after ending treatment. However, that percentage dropped to 63 percent by the fifth year. Additionally, only one-third of the women studied had an annual mammogram every year. All of the women in the study had health insurance and access to mammography centers. The results of the study are published in Cancer.

The risk of breast cancer recurrence is highest within the first five years after treatment, and survivors have three times the risk of having a recurrence as women who never had cancer. Even after a mastectomy, breast cancer can return, so no matter what the form of treatment, all breast cancer survivors should get yearly mammograms.

"It is imperative that efforts be made to increase awareness among healthcare providers and breast cancer survivors of the value of follow-up mammography," said Doubeni.

So, why would a woman who had to go through cancer treatment once, not do everything in her power to catch it early the second time?

"Denial can play a part in this," said Penny Damaskos, a social worker at Memorial Sloan-Kettering Cancer Center. Because cancer patients are so afraid of getting a positive mammogram, Damaskos explained, they prefer not knowing and assume they are safe.

Other issues, beyond simply having health insurance, like working long hours or needing to find child care, often makes avoiding a mammogram that much easier for breast cancer survivors.

To change this trend, Damaskos recommends that doctors give every patient a "roadmap" to guide their medical care after cancer treatment. This would include a list of follow-up appointments that highlights the need for annual mammograms.

For those patients who resist getting mammograms, Damaskos has found that support groups may help. In studies, women who were at high risk for breast cancer were more likely to go for their mammogram if their paired up with a "buddy" to go with to the screening.

"Having a venue in your community can help get rid of the isolation and fear that a mammogram brings," she says.