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Disparities in Breast Cancer Screening

 

 

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Mission Fast Facts: Komen's Investment in Breast Cancer Disparities
Fact Sheet

 

Some women are less likely than others to get mammography screening. There are many reasons for disparities in breast cancer screening in the U.S.

Health insurance

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 2010, only 32 percent of women ages 40 and older with no health insurance had a mammogram within the past two years compared to 71 percent of those with insurance [13].  

Although a lack of health insurance is a main reason for breast cancer screening disparities in the U.S., other factors play a role. Even among women ages 40 and older with insurance, 29 percent did not have a mammogram within the past two years [13].

Other barriers to breast cancer screening

Other barriers to mammography screening under active study include [13,89-92]:

  • Low income
  • Lack of access to care (such as lack of a local (or easy to get to) mammography center or lack of transportation to a mammography center)
  • Lack of a usual health care provider
  • Lack of a recommendation from a provider to get mammography screening
  • Lack of awareness of breast cancer risks and screening methods
  • Cultural and language differences

These may explain some of the disparities in mammography screening rates among certain populations of women, such as women from different racial/ethnic groups.  

African American women  

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Racial & Ethnic Differences
Fact Sheet

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 Figure 3.6 below). African American women have a 41 percent higher rate of breast cancer mortality (death) than white women (most recent data available) [93-94].  

Figure 3.6

Figure 1.2 - Breast cancer incidence and mortality white females versus black females 

Age-adjusted to the 2000 U.S. standard population. SEER Cancer Statistics Review: 1975-2009, 2012 [94].  

In the past, African American women were less likely than white women to get regular mammograms [95]. These lower screening rates may have increased the chances of African American women 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 about same rates of mammography use. In 2010, 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 (see Figure 3.7) [13].  

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 [96]. 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 [97-98].  

Even after accounting for differences in access to care, income level and past screening rates, African American women are diagnosed with later stage breast cancer and have worse survival than white women [99-101]. Differences in reproductive factors and the biology of breast cancers of African American women and white women also appear to play a role in these disparities [102-107].  

Learn more about factors that may impact breast cancer risk and survival among African American women 

Figure 3.7   

 

 Percentage of women 40 and older
who had a mammogram
in the past two years
 

White (non-Hispanic) 

67%

African American (non-Hispanic) 

66%

Hispanic/Latina 

64%

Asian American (non-Hispanic) 

62%

American Indian and Alaska Native 

69%

Adapted from American Cancer Society materials [13].

 

Hispanic/Latina, Asian American, Pacific Islander, American Indian and Alaska Native women

Hispanic/Latina women

Hispanic/Latina women have lower rates of breast cancer and breast cancer death (mortality) compared to African American and white women [108-109]. However, breast cancer is still 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 [109].

Hispanic/Latina women have about the same rates of breast cancer screening as African American and white women (see Figure 3.7) [13].

Asian American and Pacific Islander women

Breast cancer is the most common cancer in Korean, Chinese, Filipino and Japanese women in the U.S. [110]. Asian American and Pacific Islander tend to have lower rates of breast cancer than African American and white women [94,108]. However, some ethnic groups, including Native Hawaiian and Samoan women, have higher rates of breast cancer mortality than African American or white women [111-112]. Breast cancer screening is important for all Asian American and Pacific Islander women.

Asian American and Pacific Islander women have somewhat lower rates of breast cancer screening than African American and white women [13,113]. With less screening, women may be diagnosed with later stage breast cancers, lowering their chances for survival [13].

American Indian and Alaska Native women

Breast cancer is the most common cancer among American Indian and Alaska Native women (Native American women) [94]. Native American women tend to have lower rates of breast cancer and breast cancer mortality than white or African American women [94,108]. 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 those who live in the Southwest have the lowest rates [114]. Breast cancer screening is important for all Native American women.

Native American women and white women have about the same rates of breast cancer screening. Among women ages 40 and older, 69 percent of Native American women and 67 percent of white women had a mammogram in the past two years (see Figure 3.7) [81].  

Lesbian, gay and bisexual women

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Lesbian, Gay, Bisexual and Transgender Women
Fact Sheet

A recent study found similar rates of screening mammography among lesbian, bisexual and heterosexual women [115]. However, some findings have shown lesbian and bisexual women may not get regular mammograms [116]. This may be due to a [117]:

  • Lack of health insurance
  • Perceived low risk of breast cancer
  • Past experience of discrimination or insensitivity from health care providers
  • Low level of trust of providers

For lesbian and bisexual women, finding a provider who is sensitive to their needs may be helpful in getting regular health care, including breast cancer screening. Networking with other women may be useful in finding such a provider.    

Physical disabilities and breast cancer screening  

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Women with Disabilities
Fact Sheet

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Braille Breast Self-Awareness Brochure 

Women with physical disabilities tend to have mammograms less often than women without such limitations [118-121]. One reason is lack of access [122]. 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 that women with disabilities will return for routine mammograms [123]. 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 [124], making a powerful group to lobby for change. 

 What is Susan G. Komen® doing? 

In 2008, Susan G. Komen® and the American Association on Health and Disability (AAHD) launched Project Accessibility: Removing Barriers for Women with Disabilities. Project Accessibility staff visited 60 community mammography screening centers in the Washington D.C. area. They provided on-site center accessibility assessments, technical help and project materials. In 2011, Komen and AAHD launched another collaborative project, Bridging the Gap: No Woman Left Behind. Bridging the Gap educated women with disabilities about breast cancer through interactive educational workshops held throughout the Washington D.C. area.

In 2012, Komen and AAHD teamed up again, this time to launch Project Accessibility USA: Removing Barriers for Women with Disabilities. The $500,000, two-year project is currently underway. AAHD is collaborating with Komen Affiliates across the country to identify local grantees that provide mammography screening. They are setting up site visits to support clinic staff to ensure physical accessibility of their clinics. They are also providing technical help and educating clinic staff about meeting the needs of women with disabilities. This work is helping the clinics better serve women with disabilities.

Komen and AAHD are also working to develop a free, online Breast Health Accessibility Resource Portal with materials to help Komen grantees around the globe improve their ability to care for women with disabilities. Through Project Accessibility USA, we are changing the status quo women with disabilities and ensuring access to quality breast cancer care for all.

To learn more about Project Accessibility USA, please contact nationalcapitalarea@komen.org.

 

Removing barriers to screening

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 language barriers to screening (especially for poor and uninsured women) are vital to increasing breast cancer screening rates [91,125-126].

Community education (such as health campaigns addressing 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 [125-126]. 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 01/28/14

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