Mammography screening is important for all women, regardless of their race/ethnicity or their risk of breast cancer.
Some women are less likely than others to get mammography screening though. There are many reasons for disparities in breast cancer screening in the U.S.
A main reason behind differences in mammography screening rates in the U.S. is health insurance.
Women who don’t have health insurance are much less likely to get mammograms than women with health insurance. In 2013 (most recent data available), only 38 percent of women ages 40 and older with no health insurance had a mammogram within the past 2 years compared to 70 percent of those with insurance .
Although a lack of health insurance is a main reason for breast cancer screening disparities in the U.S., other factors play a role. As noted above, even among women ages 40 and older with insurance, only 70 percent had a mammogram within the past 2 years .
Other barriers to mammography screening may include [6,70-74]:
These may explain some of the disparities in mammography screening rates among certain populations of women, such as women from different racial and ethnic groups.
Mammography screening rates in the U.S. vary by race and ethnicity (see Figure 3.6 below).
Percentage of women 40 and olderwho had a mammogramin the past 2 years
American Indian and Alaska Native
Adapted from American Cancer Society materials .
Asian-American women in the U.S. have somewhat higher rates of breast cancer screening than African-American and white women . They also tend to have lower rates of breast cancer and breast cancer mortality (death) than African-American and white women .
However, breast cancer is the second leading cause of cancer death in Asian-American, Native Hawaiian and Pacific Islander women (lung cancer is the major cause of cancer death) .
Overall, breast cancer incidence (rate of new cases) is slightly lower among African-American women than among white women . However, breast cancer mortality (death) is higher in African-American women (see Figure 3.7 below) [1,74-75].
For example, in 2013 (most recent data available), breast cancer mortality was 39 percent higher in African-American women than in white women .
Age-adjusted to the 2000 U.S. standard population. SEER Cancer Statistics Review: 1975-2013, 2016 .
In the past, African-American women were less likely than white women to get regular mammograms . These lower screening rates may have increased the chances of African-American women being diagnosed with more advanced breast cancers. This may be one possible reason for the difference in survival rates.
African-American women and white women now have the about same rates of mammography use. In 2013 (most recent data available), among women 40 and older, 66 percent of African-American women and 66 percent of white women had a mammogram in the past 2 years (see Figure 3.6) .
Access to follow-up care after an abnormal mammogram may explain part of the survival gap between African-American and white women. Some, but not all, findings have shown that African-American women may have more delays in follow-up after an abnormal mammogram than white women [77-79]. These delays in follow-up may play a role in the lower survival rates among African-American women [75,80-81].
Even after accounting for differences in income, past screening rates and access to care, African-American women are diagnosed with more advanced breast cancers and have worse survival than white women [74,80-83].
Differences in reproductive factors and breast cancer biology between African-American women and white women also appear to play a role in these disparities [75,83-87].
Learn more about factors that may impact breast cancer risk and survival among African-American women.
American Indian and Alaska Native women (Native American women) have somewhat lower rates of breast cancer screening compared to white women.
Among women ages 40 and older, 63 percent of Native American women and 66 percent of white women had a mammogram in the past 2 years (see Figure 3.6) .
Breast cancer is the most common cancer among Native American women . Native American women tend to have lower rates of breast cancer and breast cancer mortality than white or African American women . However, these rates vary according to where women live. Native American women who live in Alaska have the highest rates of breast cancer (similar to non-Hispanic white women) and those who live in the Southwest have the lowest rates .
Hispanic/Latina women have lower rates of breast cancer and breast cancer death (mortality) compared to non-Hispanic African American and non-Hispanic white women [88-89].
However, breast cancer is still the most common cancer (and the leading cause of cancer death) among Hispanic/Latina women and breast cancer screening in these women is just as important as it is for African-American and white women .
Hispanic/Latina women have somewhat lower rates of breast cancer screening compared to other women, including non-Hispanic white women (see Figure 3.6) .
However, Hispanic/Latina women tend to be diagnosed with more advanced breast cancers than white women . This may be due to lower mammography rates as well as experiencing delays following-up after an abnormal mammogram .
Some findings show the rates of screening mammography among lesbians, bisexual women and heterosexual women are similar . However, other findings show lesbians and bisexual women may not get regular mammograms due to .
One step lesbians and bisexual women can take is to find a provider who is sensitive to their needs. Provider visits offer the chance to get health care, including breast cancer screening, on a regular basis. Networking with other women may be useful in finding such a provider.
Women with physical disabilities tend to have mammograms less often than women without such limitations [96-97]. One reason is lack of access [98-100].
Many mammography centers (especially mobile ones) simply aren't designed for women who have trouble getting around. Having a good experience increases the chances that women with disabilities will return for routine mammograms .
If you have concerns about access, call the mammography centers in your area until you find one that meets your needs. Partnering with your health care provider in your search can make things go more smoothly.
The CDC also has a tip sheet for breast cancer screening for women with disabilities. If access to mammography for disabled women is limited in your area, let your local medical centers know. This may help increase access for you and other women.
Disabled women themselves know best how to improve facilities, medical equipment and patient-provider relations.
Let your voice be heard by the larger community. If access to health care for the disabled isn't as good as it could be in your area, let your local medical centers, health insurance providers and elected officials know.
About 27 million women in the U.S. have a physical disability , making a powerful group to lobby for change.
What is Susan G. Komen doing?
Susan G. Komen and the American Association on Health and Disability (AAHD) recently worked together to address and remove barriers to screening and treatment for women with disabilities.
Komen and AAHD:
Read our blog on Project Accessibility.
To learn more about Project Accessibility USA, please contact email@example.com.
Many barriers may make it hard for some women to get breast cancer screening. Increasing access, awareness and sensitivity may help remove some of these barriers.
Improving access to mammography and primary care and removing financial and language barriers to screening (especially for poor and uninsured women) are vital to increasing breast cancer screening rates [72,103-104].
Community education (such as health campaigns that address negative beliefs and feelings about mammography) may increase awareness of the value of breast cancer screening and follow-up of abnormal mammograms.
Health care providers working with women from different communities and cultures should be sensitive to their needs. When a provider does not recommend a mammogram, some women do not feel they need one [103-104].
If you are 40 years or older (and not at higher risk of breast cancer) and your provider does not bring up mammography, ask him/her to talk with you about screening and when and how often you should get a mammogram.
Learn more about talking with your health care provider.
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*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.
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