How Do Breast Cancer Screening Rates Compare Among Different Groups in the U.S.?

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 mammograms. 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 [63]:

  • 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 [63].

Since September 2010, the Affordable Care Act has required all new health insurance plans to cover screening mammograms, with no co-payment [19]. Health plans must cover mammography at least every 2 years for women 50 and older, and as recommended by a health care provider for women 40-49 [19].

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 [114-121]:

  • 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 health care provider to get mammography screening
  • Low education level
  • Lack of knowledge of breast cancer risks and screening methods
  • Lack of child care or elder care
  • Lack of sick leave or unable to miss work
  • Fear of bad news or pain from the mammogram
  • 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 differences in mammography screening rates among certain populations of women, such as women from different racial and ethnic groups, as well as those who live in different areas of the country.

For example, women who live in rural areas, who may have limited access to health care, are less likely to get mammography screening than women who live in urban areas [120].

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)

Black

74%

White

73%

Hispanic

71%

Asian American

71%

American Indian and Alaska Native

66%

Adapted from American Cancer Society materials [121].

Black women in the U.S.

Black women have similar rates of screening mammography use as white women, Hispanic women and Asian American women [121].

Overall, the breast cancer incidence rate (rate of new cases) is lower among Black women than among white women [122].

However, the rate of breast cancer mortality is higher in Black women (see Figure 3.7 below) [123].

For example, from 2014-2018 (most recent data available), the breast cancer mortality rate was about 39 percent higher in Black women than in white women [123].

Figure 3.7

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

Age-adjusted to the 2000 U.S. standard population.
Source: 1975-2018 SEER data, 2021 [124-125]

Access to follow-up care for Black women

Access to follow-up care after an abnormal mammogram may explain part of the survival gap between Black women 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 [127-129].

Delays in follow-up may play a role in the lower survival rates among Black and African American women [130].

Other factors related to lower breast cancer survival among Black women

Even after accounting for differences in income 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. [130,132-133,163].

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

Learn about Komen’s commitment to health equity.

Age at diagnosis for Black women

Black women who develop breast cancer tend to be diagnosed at a younger age than white women [139].

The median age at diagnosis for Black women is 60, compared to 64 for white women [139].

The median is the middle value of a group of numbers, so about half of Black women are diagnosed before age 60 and about half are diagnosed after age 60. Among white women, about half are diagnosed before age 64 and about half are diagnosed after age 64.

Hispanic/Latina women in the U.S.

Overall, Hispanic women have similar rates of screening mammography as Black women, white women and Asian American women (see Figure 3.6) [121].

However, some findings show Hispanic women may have a higher number of barriers to getting screening mammograms than women of other ethnicities [115,119].

Breast cancer screening among Hispanic/Latina women by group

Mammography screening among Hispanic/Latina women varies by group. For example, women of Central/South American origin have higher screening mammography rates than Mexican American women [140].

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 may be more likely to get mammograms [140].

The importance of mammography for Hispanic/Latina women

Hispanic women have lower rates of breast cancer and breast cancer mortality compared to Black women and white women [122-123].

However, breast cancer is still the most common cancer (and the leading cause of cancer death) among Hispanic women [140]. So, screening mammography is just as important for Hispanic/Latina women as it is for Black women and white women.

Hispanic women tend to be diagnosed with more advanced breast cancers than white women [140]. This may be due to more delays in follow-up care after an abnormal mammogram [140].

American Indian and Alaska Native women

American Indian women and Alaska Native women have somewhat lower rates of breast cancer screening compared to other women [121].

Among women ages 50-74, 66 percent of American Indian and Alaska Native women had a mammogram in the past 2 years compared to 74 percent of Black women and 73 percent of white women (see Figure 3.6) [121].

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 [141].

Breast cancer screening among American Indian and Alaska Native women by group

Screening mammography rates among American Indian and Alaska Native women vary depending on where women live [163]. Women who live in the Southern Plains and Alaska have higher rates of screening mammography than women who live in the Pacific Coast [163].

The importance of mammography for American Indian and Alaska Native women

Breast cancer is the most common cancer among American Indian and Alaska Native women [163].

American Indian and Alaska Native women tend to have lower rates of breast cancer and breast cancer mortality than Black women or white women [122-123]. However, American Indian and Alaska Native women are less likely than white women to be diagnosed with early-stage breast cancer that has not spread to the lymph nodes [181].

Breast cancer rates vary according to where American Indian and Alaska Native women live.

American Indian and Alaska Native women who live in the Southern Plains, the Northern Plains and Alaska have the highest rates of breast cancer incidence, higher than incidence rates among white women in these areas [142-143,163]. Those who live in the Southwest and the East have lower rates [142-143,163].

Asian American, Native Hawaiian and Pacific Islander women in the U.S.

Asian American women in the U.S. have similar rates of screening mammography as Black women, white women and Hispanic women [121].

However, compared to white women, Asian women in the U.S. have more delays in follow-up care after an abnormal mammogram [144].

Asian and Pacific Islander women tend to have lower rates of breast cancer and breast cancer mortality (death) than Black women and white women [122-123].

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) [163]. So, screening is just as important as it is for Black women and white women.

Gay, lesbian and bisexual women, transgender people and nonbinary people

Screening mammography rates among lesbians and bisexual women are similar to or higher than screening mammography rates among heterosexual women [145-146].

In 2018 (most recent data available) [63,121]:

  • 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

Data on screening mammography in transgender people and nonbinary people are limited.

Some lesbians and bisexual women may not get regular mammograms. This may be due to [147-148]:

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

One step you can take is to find a health care provider who is sensitive to your needs. Getting a referral from a trusted friend may help. The National LGBT Cancer Network has a directory of LGBT-welcoming cancer screening centers that may also be helpful.

See a health care provider regularly to get breast cancer screening and other health care. Discuss your risk of breast cancer with your provider.

Women with physical disabilities

Women with physical disabilities tend to get mammograms less often than women without such limitations [149-150]. One reason is lack of access to mammography centers that meet their needs [150-152].

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 [153].

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 may help.

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. 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 [154], 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 breast cancer screening and treatment for women with disabilities.

Komen and AAHD launched Project Accessibility USA to change the status quo for women with disabilities and ensure access to quality breast cancer care for all.

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 [119,121,155]:

  • 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

Since September 2010, the Affordable Care Act has required all new health insurance plans to cover screening mammograms, with no co-payment [19]. Health plans must cover mammography at least every 2 years for women 50 and older, and as recommended by a health care provider for women 40-49 [19].

Since the Affordable Care Act became law, the gaps in screening mammography between women with high and low income levels have declined [156]. Gaps in screening mammography rates between women with high and low education levels also have declined [156].

Find resources for low-cost or free mammograms.

Talk with your health care provider about breast cancer screening

  • If you’re at higher than average risk of breast cancer, talk with your health care provider about when to start breast cancer screening. You may need to be screened earlier and more often than other women. You may also benefit from other imaging, such as breast MRI.
  • If you’re 40 or older (and at 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.

Komen believes all women should have access to regular screening mammograms when they and their health care providers decide it is best based on their personal risk of breast cancer.

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 can be treated. With standard treatment, people who have breast cancers found by screening mammography have a high chance of survival.

Learn more about follow-up after an abnormal mammogram.

Updated 03/03/22