Recent data confirms breast cancer to be the leading cancer amongst women in sub-Saharan Africa and the second cause of cancer-related deaths. Screening and early diagnosis are the main pillars in the management of breast cancer in resource-limited settings. This study explored mammography utilization and challenges in a peripheral referral hospital in Cameroon. To achieve this aim, a hospital-based sequential explanatory mixed-methods study was conducted. Quantitative data was extracted from the mammography registry over a five-year period, after which in-depth interviews were conducted for some clients randomly selected from the registry. A total of 392 clients had a mammogram during the study period and all were females. The median age was 47 years (range: 20 to 73 years). There were 126 screening mammograms (32.14%; 95% confidence interval: 27.54 – 37.02%). The fear of a diagnosis of breast cancer was reported to be an important factor in getting a mammogram, but also deterred some who did not consider themselves able to afford for care in the event of such a diagnosis. Other important factors associated with obtaining a mammogram were the death of a relative, friend, colleague or acquaintance attributed to breast cancer. Many respondents did not know about mammography and its availability in the local reference hospital. These findings indicate low levels of awareness and under-utilization of mammography. Campaigns to educate and raise public awareness about breast cancer screening may be important to improve mammography uptake and increase the proportion of screening studies.