Comparing Breast Cancer Screening Rates Among Different Groups

Mammography screening is important for all women, regardless of their race/ethnicity or their risk of breast cancer. Along with follow-up tests, and treatment if diagnosed, mammography can reduce the chance of dying from breast cancer.

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. Some are described here.

Learn about Komen’s work to end breast cancer disparities.

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 than women with health insurance to get mammograms.

In 2018 (most recent data available), among women ages 50-74 [65]:

  • 39 percent of those with no health insurance had a mammogram in the past 2 years
  • 75 percent of those with health insurance had a mammogram in the past 2 years

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 who had insurance in 2018, only 75 percent had a recent mammogram [65].

The Affordable Care Act requires all new health insurance plans (since September 2010) to cover mammography screening every 1-2 years (with no co-payment) for women ages 40 and older [16].

Learn more about Medicare, Medicaid and insurance company coverage of mammograms.

Find resources for low-cost or free mammograms.

Learn about health insurance.

Other barriers to breast cancer screening

Other barriers to mammography screening may include [101-108]:

  • Low income (or worry about cost)
  • 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
  • Low education level
  • Lack of knowledge of breast cancer risks and screening methods
  • Lack of child care
  • Lack of sick leave or unable to miss work
  • Fear of bad news or pain from the procedure
  • More recent migration to the U.S. (born outside the U.S. and living in the U.S. for less than 10 years)
  • 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 and ethnic groups.

Race and ethnicity

Mammography screening rates in the U.S. vary by race and ethnicity (see Figure 3.6 below).

Figure 3.6

 

Percentage of women ages 50-74 who had a mammogram in the past 2 years in 2018 (most recent data available)

Non-Hispanic Black

74%

Non-Hispanic White

73%

Hispanic

71%

Non-Hispanic Asian American

71%

Non-Hispanic American Indian and Alaska Native

66%

Adapted from American Cancer Society materials [65].

Black and African American women

Overall, breast cancer incidence (rate of new cases) is lower among Black women than among white women [109].

However, breast cancer mortality is higher in Black and African American women (see Figure 3.7 below) [109-110]. 

For example, from 2013-2017 (most recent data available), breast cancer mortality was about 39 percent higher in Black women than in white women [109].

Figure 3.7

Figure 3.7 Breast Cancer Incidence and Mortality Between Black Women and White Women  

Age-adjusted to the 2000 U.S. standard population. SEER Cancer Statistics Review: 1975-2017, 2020 [111-112].

Past screening rates among Black and African American women

In the past, African American women were less likely than white women to get regular mammograms [113]. Lower screening rates in the past may be a possible reason for the difference in survival rates today.

Black women now have slightly higher rates of mammography use than other women [65].

In 2018 (most recent data available), among non-Hispanic Black women ages 50-74, 74 percent had a mammogram in the past 2 years (see Figure 3.6) [65].

Access to follow-up care for Black and African American women

Access to follow-up care after an abnormal mammogram may explain part of the survival gap between Black and African American, and white women.

Some findings have shown Black and African American women may have more delays in follow-up after an abnormal mammogram than white women [101,114-116].

Delays in follow-up may play a role in the lower survival rates among Black and African American women [117-118].

Other factors related to lower breast cancer survival among Black and African American women

Even after accounting for differences in income, past screening rates and access to care, Black and African American women are diagnosed with more advanced breast cancers and have worse survival than white women in the U.S. [101,117-120].

Differences in reproductive factors and breast cancer biology between Black and African American women and white women also appear to play a role in these disparities [110,120-125]. For example, Black and African American women are more likely than white women to be diagnosed with triple negative breast cancer, an aggressive breast cancer [110,119,122-125].

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

Age at diagnosis for Black and African American women

Black women who develop breast cancer tend to be diagnosed at a younger age than white women [1].

The median age at diagnosis for Black women is 60, compared to 63 for white women [1].

The median is the middle value of a group of numbers, so about half of Black and African American women are diagnosed before age 60 and about half are diagnosed after age 60. Among white women, about half are diagnosed before age 63 and about half are diagnosed after age 63.

Hispanic/Latina women

Overall, Hispanic women have somewhat lower rates of breast cancer screening compared to non-Hispanic Black women and non-Hispanic white women (see Figure 3.6) [65]. However, the gap between breast cancer screening in Hispanic women and breast cancer screening in Black and white women has gotten smaller over time [126].

Some findings show Hispanic women may have a higher number of barriers to getting screening mammograms than women of other ethnicities [104].

Breast cancer screening among Hispanic/Latina women by group

Mammography screening among Hispanic/Latina women varies by group. For example, Puerto Rican women are more likely to get screening mammograms than non-Hispanic white women [126].

Puerto Rican women are also more likely to get screening mammograms than Cuban American and Mexican American women [126].

In addition, compared to Hispanic women who have lived in the U.S. for a short period of time, those who have lived in the U.S. for a long period of time are more likely to get mammograms [126].

The importance of mammography for Hispanic/Latina women

Hispanic women have lower rates of breast cancer and breast cancer mortality compared to Black/non-Hispanic Black and white/non-Hispanic white women [65,109,126-127].

However, breast cancer is still the most common cancer (and the leading cause of cancer death) among Hispanic/Latina women [126]. So, screening is just as important as it is for Black and African American women, and white women.

Hispanic/Latina women tend to be diagnosed with more advanced breast cancers than white women [126]. This may be due to lower mammography rates and more delays in follow-up care after an abnormal mammogram [126].

American Indian and Alaska Native women

Non-Hispanic American Indian women and non-Hispanic Alaska Native women have somewhat lower rates of breast cancer screening compared to non-Hispanic Black women and non-Hispanic white women [65].

Among women ages 50-74, 66 percent of non-Hispanic American Indian and non-Hispanic Alaska Native women had a mammogram in the past 2 years compared to 74 percent of non-Hispanic Black women and 73 percent of non-Hispanic white women (see Figure 3.6) [65].

One reason for these differences in screening rates may be access to care. American Indian and Alaska Native women tend to live in areas that require traveling a long distance to get health care, including mammography [128].

Breast cancer is the most common cancer among American Indian and Alaska Native women [127].

American Indian and Alaska Native women tend to have lower rates of breast cancer and breast cancer mortality than white/non-Hispanic white or Black/non-Hispanic Black women [65,109,127]. However, these rates vary according to where women live.

American Indian and Alaska Native who live in Alaska have the highest rates of breast cancer (similar to non-Hispanic white women) and those who live in the East, Southwest and Pacific Coast have the lowest rates [129-130].

Asian American, Native Hawaiian and Pacific Islander women

Non-Hispanic Asian American women in the U.S. have somewhat lower rates of breast cancer screening than other women [65]. Compared to white women, Asian women in the U.S. also have more delays in follow-up care after an abnormal mammogram [131].

Asian and Pacific Islander women tend to have lower rates of breast cancer and breast cancer mortality (death) than Black women and white women [65,109].

However, breast cancer is the second leading cause of cancer death in Asian and Pacific Islander women (lung cancer is the major cause of cancer death) [127]. So, screening is just as important as it is for Black and African American women, and white women.

Gay, lesbian and bisexual women

Screening mammography rates among lesbians and bisexual women are similar to or higher than screening mammography rates among heterosexual women [65,132].

In 2018 (most recent data available) [65]:

  • 79 percent of gay and lesbian women ages 50-74 had a mammogram in the past 2 years
  • 73 percent of straight women ages 50-74 had a mammogram in the past 2 years

However, some lesbians and bisexual women may not get regular mammograms. This may be due to [133-134]:

  • Lack of health insurance
  • Perceived low risk of breast cancer
  • Past discrimination or insensitivity from health care providers
  • Low level of trust of providers
  • Having trouble finding a provider

One step you can take is to find a provider who is sensitive to your needs. Getting a referral from a trusted friend may help.

Regular provider visits offer the chance to discuss your risk of breast cancer, get breast cancer screening and get other health care.

Women with physical disabilities

Women with physical disabilities tend to get mammograms less often than women without such limitations [135-136]. One reason is lack of access to mammography centers that meet their needs [137-138].

Many mammography centers (especially mobile ones) simply aren’t designed for women who have trouble getting around.

Having a good experience increases the chances women with disabilities will return for routine mammograms [139].

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.

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.

The CDC has a tip sheet for breast cancer screening for women with disabilities.

Getting involved

Women with disabilities themselves know best how to improve mammography centers, medical equipment and patient-doctor relations.

Let your voice be heard by the larger community. If access to health care for people with disabilities isn’t as good as it could be in your area, let your local medical centers, health insurance companies and elected officials know.

About 36 million women in the U.S. have a physical disability [140], 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) worked together to address and remove barriers to screening and treatment for women with disabilities.

Komen and the AAHD:

  • Launched Project Accessibility USA to change the status quo for women with disabilities and ensure access to quality breast cancer care for all.
  • Launched Project Accessibility: Removing Barriers for Women with Disabilities to improve access to care for women living with disabilities in Washington, D.C.
  • Developed a free, online Breast Health Accessibility Resource Portal with materials to help Komen grantees around the world improve their ability to care for women with disabilities.

 

Removing barriers to screening

Many barriers may make it hard for some women to get breast cancer screening and follow-up on abnormal mammograms.

Increasing access, awareness and sensitivity may help remove some barriers (especially for poor and uninsured women). This includes [101,141-142]:

  • Improving access to mammography and primary care
  • Removing financial barriers
  • Removing language barriers
  • Community education (such as health campaigns that address negative beliefs and feelings about mammography)
  • Ensuring health care providers are sensitive to the needs of women from different communities and cultures. When a provider doesn’t recommend a mammogram, some women don’t feel they need one.

The Affordable Care Act

A goal of the Affordable Care Act was to reduce barriers to health care. It requires all new health insurance plans (since September 2010) to cover mammography screening every 1-2 years (with no co-payment) for women ages 40 and older [16].

Since the time the Affordable Care Act became law, the gaps in screening mammography between women with high and low income levels, and between women with high and low education levels, have declined [143].

Find resources for low-cost or free mammograms.

Talk with your health care provider about breast cancer screening

If you are 40 years or older (and not at higher than average risk of breast cancer), talk with your health care provider about breast cancer screening. Discuss when and how often you should get a mammogram.

Learn more about talking with your health care provider

Get follow-up tests without delay

If your mammogram shows something abnormal, you’ll need follow-up tests to check whether or not the finding is breast cancer. A patient navigator at your medical center may help you arrange follow-up testing.

Be sure to get follow-up care without delay. If breast cancer is found, it’s best to be diagnosed and treated at the earliest possible stage.

Learn more about follow-up after an abnormal mammogram.