Breast cancer screening through mammography is a vital preventive measure recommended for all women, irrespective of their racial or ethnic background or individual breast cancer risk. Early detection via mammograms, coupled with timely follow-up tests and treatment when necessary, significantly improves survival rates and reduces the likelihood of mortality from breast cancer.
However, access to and utilization of screening mammography are not uniform across all populations. Significant disparities exist, with certain groups of women being less likely to undergo recommended screenings. These inequities in breast cancer screening in the U.S. stem from a complex interplay of factors, which we will explore in detail.
To further understand the broader context of health equity, you can learn more about Susan G. Komen®’s initiatives to advance health equity.
Health Insurance and Screening Access
A primary factor contributing to the observed differences in screening mammography rates across the U.S. is health insurance coverage.
Women who lack health insurance are significantly less likely to receive screening mammograms compared to their counterparts with insurance coverage.
Data from 2021, the most recent available, reveals stark contrasts in screening rates among women aged 50-74 [162].
- Among uninsured women, only 42% had a screening mammogram within the past two years.
- This rate increases to 71% for women with Medicaid or other public health insurance.
- The highest rate, 80%, is observed among women with private health insurance.
For women aged 65 and older in 2021 [162], those covered by Medicare showed a screening rate of 75% within the past two years.
While lack of health insurance is a major impediment, it is not the sole determinant of breast cancer screening disparities. As the data indicates, even among insured women aged 50-74, a notable percentage (ranging from 20% to 29%) did not receive recent screening mammograms [162]. This highlights the presence of other significant barriers.
The Affordable Care Act, since September 2010, mandates that all new health insurance plans must cover screening mammograms without any co-payment [19]. This legislation requires health plans to cover mammography at least biennially for women aged 50 and older, and as recommended by a healthcare provider for women aged 40-49 [19].
For more detailed information, explore Medicare, Medicaid and insurance company coverage of mammograms.
Resources for low-cost or free mammograms are also available.
Further information on health insurance can be found here.
Additional Obstacles to Breast Cancer Screening
Beyond insurance coverage, a range of other barriers can impede access to mammography screening [65,115-120,162]. These include:
- Financial constraints and concerns about the cost of screening.
- Limited access to healthcare facilities, such as transportation challenges to mammography centers.
- Absence of a regular healthcare provider to recommend and facilitate screening.
- Lack of recommendation for mammography screening from a healthcare professional.
- Lower levels of education, potentially impacting awareness and health literacy.
- Insufficient knowledge regarding breast cancer risks and available screening methods.
- Caregiving responsibilities, including childcare or eldercare, that may hinder appointment attendance.
- Lack of paid sick leave or inability to take time off work for screening appointments.
- Fear of receiving unfavorable news or experiencing pain during the mammogram procedure.
- Recent immigration to the U.S. (within the last 10 years), potentially associated with cultural and linguistic barriers.
- Cultural and language differences that may affect communication and healthcare navigation.
These factors can partially explain the observed disparities in screening mammography rates among various populations of women, including those from different racial and ethnic groups and those residing in diverse geographic locations.
For instance, women in rural areas, who often face greater limitations in healthcare access, are less likely to undergo screening mammograms compared to women in urban settings [121].
Racial and Ethnic Variations in Screening Rates
Screening mammography rates in the U.S. exhibit variations across different racial and ethnic groups, as illustrated in Figure 3.6 below.
Figure 3.6
| Percentage of women ages 50-74 who had a screening mammogram in the past 2 years in 2021 (most recent data available) | |
|---|---|
| Black | 82% |
| White | 76% |
| Hispanic | 74% |
| Asian | 67% |
| American Indian and Alaska Native | 59% |
| Adapted from American Cancer Society materials [162]. |
Breast Cancer Screening in Black Women
In 2021, data indicates that Black women in the U.S. had the highest rates of screening mammography compared to other racial and ethnic groups [162].
Interestingly, the overall incidence rate of breast cancer (new cases) is actually lower among Black women than white women [174].
However, a concerning disparity emerges in breast cancer mortality rates. Black women experience a significantly higher breast cancer mortality rate compared to white women (refer to Figure 3.7 below) [175].
For instance, from 2018 to 2021, the breast cancer mortality rate for Black women was approximately 37% higher than that for white women [175].
Figure 3.7
Figure 1.2 Breast Cancer Incidence and Mortality Between Black Women and White Women
Age-adjusted to the 2000 U.S. standard population. Source: 1975-2022 SEER data, 2024 [176-177]
Follow-up Care Disparities for Black Women
One factor that may contribute to the survival gap between Black and white women is access to timely and effective follow-up care after an abnormal mammogram result.
Research suggests that Black and African American women may experience greater delays in receiving follow-up care after an abnormal mammogram compared to white women [128-130].
These delays in follow-up can play a significant role in the lower survival rates observed among Black and African American women [131].
Other Contributing Factors to Survival Disparities in Black Women
Even after accounting for differences in income and healthcare access, Black women in the U.S. are more likely to be diagnosed with breast cancer at later, more advanced stages and experience poorer survival outcomes compared to white women [131-133,186].
To delve deeper into the factors influencing breast cancer risk and survival among Black women, explore factors that may impact breast cancer risk and survival among Black women.
Learn more about Susan G. Komen®’s initiatives to advance health equity.
Read the Stand for H.E.R. – A Healthy Equity Revolution breast cancer impact report for further insights.
Age at Diagnosis in Black Women
Breast cancer diagnosis tends to occur at a younger age for non-Hispanic Black women compared to non-Hispanic white women [178].
Between 2017 and 2021, the median age at breast cancer diagnosis for non-Hispanic Black women was 61 years, while for non-Hispanic white women, it was 65 years [178].
The median represents the midpoint value in a dataset. This data indicates that approximately half of non-Hispanic Black women are diagnosed with breast cancer before the age of 61, and half after. Similarly, for non-Hispanic white women, the median age of diagnosis is 65.
Breast Cancer Screening Among Hispanic/Latina Women
In 2021, Hispanic women exhibited screening mammography rates comparable to white women but lower than those of Black women (refer to Figure 3.6) [162].
However, research suggests that Hispanic women may encounter a greater number of barriers to accessing screening mammograms compared to women of other ethnicities [116,120].
Screening Variations within Hispanic/Latina Subgroups
Mammography screening rates among Hispanic/Latina women are not uniform and vary across different subgroups. For example, women of Central/South American origin tend to have higher screening mammography rates compared to Mexican American women [136].
Importance of Mammography for Hispanic/Latina Women
While Hispanic women have lower rates of both breast cancer incidence and mortality compared to non-Hispanic Black and non-Hispanic white women [174-175], breast cancer remains the most prevalent cancer and the leading cause of cancer-related deaths among Hispanic women [136,187]. Furthermore, Hispanic women are often diagnosed with breast cancer at more advanced stages than white women [136]. Therefore, screening mammography is equally crucial for Hispanic/Latina women as it is for Black and white women.
Breast Cancer Screening in Asian American, Native Hawaiian, and Pacific Islander Women
Data from 2021 shows that Asian American women in the U.S. had lower rates of screening mammography compared to Black, white, and Hispanic women [162].
Additionally, compared to white women, Asian women in the U.S. experience longer delays in receiving follow-up care after an abnormal mammogram result [141].
Non-Hispanic Asian and Pacific Islander women generally have lower breast cancer incidence and mortality rates compared to non-Hispanic Black and non-Hispanic white women [174-175].
Despite this, breast cancer is the second leading cause of cancer death in Asian and Pacific Islander women, with lung cancer being the primary cause [187]. This underscores the importance of screening mammography for Asian American, Native Hawaiian, and Pacific Islander women, comparable to its importance for Black and white women.
Breast Cancer Screening Among Native American and Alaska Native Women
In 2021, although data is limited, American Indian and Alaska Native women exhibited the lowest rates of breast cancer screening compared to other groups [162].
Specifically, among women aged 50-74, only 59% of American Indian and Alaska Native women had a mammogram in the past two years, compared to 82% of Black women and 76% of white women (refer to Figure 3.6) [162].
Limited access to healthcare facilities is a significant factor contributing to these disparities. American Indian and Alaska Native women often reside in areas requiring extensive travel to access healthcare services, including screening mammography [137].
Screening Rate Variations within Native American and Alaska Native Subgroups
Screening mammography rates among American Indian and Alaska Native women vary based on geographic location [1]. Women in the Southern Plains and Alaska regions have higher screening rates compared to those residing in the Pacific Coast region [1].
Significance of Mammography for Native American and Alaska Native Women
Breast cancer is the most frequently diagnosed cancer among American Indian and Alaska Native women [187].
While non-Hispanic American Indian and Alaska Native women tend to have lower breast cancer incidence and mortality rates than non-Hispanic Black or non-Hispanic white women [174-175], they are less likely than non-Hispanic white women to be diagnosed with early-stage breast cancer that has not spread to the lymph nodes [179].
Breast cancer rates also fluctuate based on the geographic location of American Indian and Alaska Native women.
American Indian and Alaska Native women in the Southern Plains, Northern Plains, and Alaska regions have the highest breast cancer incidence rates, exceeding those of white women in the same areas [1,139-140]. Conversely, those in the Southwest and East regions have lower rates [1,139-140].
Breast Cancer Screening in Gay, Lesbian, and Bisexual Women, Transgender, and Nonbinary Individuals
For insights into breast health within the LGBTQ+ community, listen to the Real Pink podcast, Breast Health in the LGBTQ+ Community.
Screening mammography rates among lesbian and bisexual women are generally similar to those of heterosexual women [162,165].
Data from 2021 [162] indicates:
- 78% of gay and lesbian women aged 50-74 had a mammogram in the past two years.
- 76% of straight women in the same age group had a mammogram in the past two years.
Data on screening mammography in transgender and nonbinary individuals remains limited.
Some lesbians and bisexual women may not undergo regular mammograms due to factors such as [144-145,165]:
- Lack of health insurance coverage.
- Perceived lower risk of breast cancer.
- Past experiences of discrimination or insensitivity from healthcare providers.
- Lower levels of trust in healthcare providers.
- Difficulties in finding a healthcare provider.
Finding a healthcare provider who is sensitive and understanding of individual needs is a crucial step. Referrals from trusted friends or resources like the National LGBT Cancer Network, which provides a directory of LGBT-welcoming cancer screening centers, can be valuable.
Regular consultations with a healthcare provider offer opportunities to discuss breast cancer risk, screening options, and other necessary health concerns.
Learn more about breast cancer screening for transgender individuals.
Breast Cancer Screening for Women with Physical Disabilities
Women with physical disabilities tend to have lower rates of mammography screening compared to women without disabilities [146-147]. This is often attributed to limited accessibility of mammography centers to accommodate their specific needs [147-149].
Many mammography facilities, particularly mobile units, are not designed to be accessible for women with mobility challenges.
Positive experiences during mammography screenings are crucial in encouraging women with disabilities to return for routine screenings [150].
If accessibility is a concern, contacting mammography centers in your area to inquire about their facilities and accommodations is recommended. Collaborating with your healthcare provider in this search can also be helpful.
If limited accessibility to mammography for women with disabilities is an issue in your community, informing local medical centers can raise awareness and potentially improve access for you and others.
The CDC provides a tip sheet for breast cancer screening for women with disabilities.
Advocacy and Involvement
Women with disabilities are uniquely positioned to provide valuable insights into improving mammography centers, medical equipment, and patient-provider interactions.
Your voice matters. If healthcare access for people with disabilities in your area is not adequate, advocate for change by informing local medical centers, health insurance companies, and elected officials.
With approximately 36 million women in the U.S. living with a physical disability [151], collective advocacy can be a powerful force for positive change.
| What is Susan G. Komen® doing? |
|---|
| Komen, in partnership with the American Association on Health and Disability (AAHD), is actively working to address and eliminate barriers to breast cancer screening and treatment for women with disabilities. The Project Accessibility USA initiative, launched by Komen and AAHD, aims to enhance care and ensure equitable access to high-quality breast cancer care for all women with disabilities. |
Removing Barriers to Enhance Screening Access
Numerous barriers can impede women’s access to breast cancer screening and timely follow-up for abnormal mammograms.
Improving access, raising awareness, and fostering sensitivity are crucial steps in removing these barriers, particularly for women with low incomes and those without health insurance. These efforts include [65,120,152,162]:
- Enhancing access to mammography services and primary care.
- Eliminating financial obstacles to screening.
- Overcoming language barriers through culturally competent services.
- Implementing community education initiatives, such as health campaigns, to address negative perceptions and anxieties surrounding mammography.
- Ensuring healthcare providers are culturally sensitive and responsive to the diverse needs of women from different communities and backgrounds. When healthcare providers recommend mammography, women are more likely to understand its importance and undergo screening.
The Affordable Care Act’s Impact
Since its implementation in September 2010, the Affordable Care Act has mandated that all new health insurance plans must cover screening mammograms without co-payments [19]. This law requires health plans to cover mammography at least every two years for women aged 50 and older, and as recommended by a healthcare provider for women aged 40-49 [19].
The Affordable Care Act has contributed to a reduction in the disparities in screening mammography rates between women with high and low-income levels [153]. Gaps in screening rates based on education levels have also narrowed since the implementation of the ACA [153].
Find resources for low-cost or free mammograms to further reduce financial barriers.
Open Communication with Healthcare Providers
Komen advocates for universal access to regular screening mammograms for all women, based on shared decision-making between women and their healthcare providers, considering individual breast cancer risk factors.
Learn more about talking with your healthcare provider to facilitate informed decisions about screening.
Prompt Follow-up is Crucial
If a mammogram reveals an abnormality, timely follow-up tests are essential to determine whether breast cancer is present. Patient navigators at medical centers can assist in coordinating follow-up testing appointments.
Ensuring prompt follow-up care is critical. If breast cancer is diagnosed, early treatment significantly improves outcomes. Breast cancers detected through screening mammography have a high chance of survival with standard treatment protocols.
For further information, learn more about follow-up after an abnormal mammogram.
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Updated 01/30/25
