Some women are less likely than others to get mammography screening. A main reason behind differences in mammography screening is health insurance. Women who lack health insurance are much less likely to get mammograms than women with health insurance. For example, in 2010, 71 percent of women ages 40 and older with insurance had a mammogram within the past two years compared to only 32 percent of those who lacked coverage [14].
Other barriers to mammography screening under active study include [14,102-105]:
- Low income
- Lack of access to care
- Lack of a usual provider
- Lack of awareness of breast cancer risks and screening methods
- Cultural and language differences
These may explain some disparities in mammography screening rates among certain populations of women, such as women from different racial/ethnic groups.
African American women
For African American women, the risk of getting breast cancer is lower than for white women, but the risk of dying from breast cancer is higher (see below). Currently, African American women have a 41 percent higher rate of breast cancer mortality (death) than white women [77-78].
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Age-adjusted to the 2000 U.S. standard population. SEER Cancer Statistics Review: 1975-2009, 2012 [78].
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In the past, African American women were less likely than white women to get regular mammograms [79-80]. These lower rates of screening among African American women increased the chances of being diagnosed with a later stage breast cancer. This may be one possible reason for the difference in survival rates.
African American women and white women now have the same rate of mammography use. In 2010, 73 percent of both African American and white women ages 50 to 74 had a mammogram within the past two years (see Figure 3.6) [81]. And, among women 40 and older, 66 percent of African American women and 67 percent of white women had a mammogram in the past two years [14].
Access to follow-up care after an abnormal mammogram may explain some, but not all, of the survival gap between African American and white women. A recent study showed race was not a factor in delays in follow-up care after an abnormal mammogram [82]. However, some studies have found that not getting proper follow-up care after an abnormal mammogram may be a factor in the lower survival rates among African American women [83-84].
Even after accounting for differences in access to care and socioeconomic status and past differences in screening rates, African American women have shorter survival times and more advanced tumors at diagnosis [85-87]. Differences in reproductive factors and the biology of breast cancers of African American women and white women also appear to play a role in survival differences [88-92].
Learn more about factors that may impact breast cancer risk and survival among African American women.
Figure 3.6
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Percentage of women 50 to 74 years
who had a mammogram
in the past two years
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White
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73%
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African American
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73%
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Hispanic/Latina
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70%
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Asian American and Pacific Islander
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64%
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American Indian and Alaskan Native
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69%
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Adapted from Centers for Disease Control and Prevention [81].
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Hispanic/Latina, Asian American, Pacific Islander, American Indian and Alaskan Native women
Hispanic/Latina women
Hispanic/Latina women have lower rates of breast cancer and breast cancer mortality compared to African American and white women [78,93-94]. However, breast cancer is the most common cancer among Hispanic/Latina women and breast cancer screening in these women is just as important as it is for African American and white women [94].
Hispanic/Latina women have about the same rates of breast cancer screening as African American and white women (see Figure 3.6) [81].
Asian American and Pacific Islander women
Breast cancer is the most common cancer in Korean, Chinese, Filipino and Japanese women in the United States [95]. Asian American and Pacific Islander tend have lower rates of breast cancer than African American and white women [78,93]. However, some ethnic groups, including Native Hawaiian and Samoan women, have higher rates of breast cancer mortality than African American or white women [96-97]. Breast cancer screening is important for all Asian American and Pacific Islander women.
Asian American and Pacific Islander women have lower rates of breast cancer screening than African American and white women [81]. With less screening, women may be diagnosed later, lowering their chances for survival [14,98-100].
American Indian and Alaskan Native women
Native American women have lower rates of breast cancer and breast cancer mortality than white or African American women [81,93]. 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 white women) and women who live in the Southwest have the lowest rates [101]. Breast cancer screening is important for all Native American women.
Native American women have lower rates of breast cancer screening compared to African American and white women (see Figure 3.6) [81]. With less screening, women may be getting diagnosed later, lowering their chances for survival [14,98-100].
Lesbian, gay and bisexual women
Some research shows lesbian and bisexual women may not get regular mammograms [107-108]. This may be due to lack of insurance, financial hardship, and/or a perceived lower risk of breast cancer. Lesbian and bisexual women may also have past experiences of discrimination or insensitivity from health care providers or lower levels of trust of providers [109-110].
For lesbian and bisexual women, finding a provider who is sensitive to their needs may be helpful in getting regular health care, including screening. Networking with other women may be useful in finding such a provider.
Physical disabilities and breast cancer screening
Women with physical disabilities tend to have mammograms less often than women without such limitations [111-114]. One reason is lack of access [115]. Many mammography centers (especially mobile ones) simply aren't designed for women who have trouble getting around. One solution is to call the mammography centers in your area until you find one that meets your needs.
Having a good experience increases the chances women with disabilities return for routine mammograms [116]. Partnering with your health care provider in your search can make things go more smoothly. 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.
Getting involved
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 [117], making a powerful group to lobby for change.
Removing barriers to screening
Improving access to mammography and primary care and removing language barriers to screening (especially for poor and uninsured women) are vital to increasing screening rates [104,118-120]. Community education (such as health campaigns addressing common negative beliefs and feelings about mammography) may increase awareness of the value of regular 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 [119-120]. If you are 40 years or older and your provider does not bring up mammography, ask him/her to talk to you about breast health and screening.
Learn more about talking to your health care provider.
Updated 04/03/13
