Not all patient care access is equal when it comes to mammograms, CDC report finds

Approximately 40,000 women die of breast cancer in the U.S. each year.

One way of reducing that number is ensuring access to preventive screenings such as mammograms. But health-related social needs can have an impact on a woman’s chance of being up to date with her mammogram. For example, women are less likely to get a mammogram if they feel socially isolated, have lost a job or don’t have reliable transportation, according to a recent Centers for Disease Control and Prevention (CDC) Vital Signs report.

About 1 in 4 women ages 50 to 74 years had not received a mammogram in the past two years in 2022.

The more health-related social needs a woman has, the less likely she is to be up to date with mammograms that screen for breast cancer. Only about 7 in 10 women ages 50 to 74 years (65.7%) with three or more health-related social needs were up to date with mammograms, the report showed.

Women who reported cost as a barrier to access healthcare had about two times the odds of not getting a mammogram, according to the CDC.

By contrast, mammography prevalence among women in the same age group with no adverse social determinants of health or health-related social needs was 83.2%, or about 8 in 10.

“Life dissatisfaction, feeling socially isolated, experiencing lost or reduced hours of employment, receiving food stamps, lacking reliable transportation, and reporting cost as a barrier for access to care were all strongly associated with not having had a mammogram within the previous two years,” the report authors noted.

And while, also, breast cancer death rates have been decreasing in general, such reductions have not been equitable among certain demographics. Women, for example, who are non-Hispanic Black or African American, as well as those who have low incomes, are more likely to die from breast cancer.

Using 2022 data, mammography use also varied by state as well as sociodemographic characteristics. For example, such use ranged from 44.5% in New Mexico to 77.8% in South Dakota among women aged 40-49 years old. In women aged 50-74, that range was from 64% in Wyoming to 85.5% in Rhode Island.

Among women in both age groups, cost as barrier to healthcare access was the measure most strongly associated with not having a mammogram within the past two years, the report said.

Possible solutions?

Evidence-based interventions like client reminders, videos, brochures, flyers, postcards, newsletters and efforts to reduce structural barriers can help increase mammography use. Researchers note that addressing social needs also could result in increased mammography use and therefore help lead to further declines in breast cancer deaths.

“Healthcare facilities, providers and public health programs could consider developing policies and effective practices to conduct risk assessments for adverse social determinants of health and health-related social needs and address SDOH and HRSNs such as cost to access health care, social isolation, lack of reliable transportation and food insecurity,” the report concluded.

Various studies have also shown evidence-based indicators that include programs providing healthy food options and equitable access to transportation can increase healthcare adherence.

A multipronged approach may be necessary, too, including using a new Centers for Medicare & Medicaid Services-administered billing code allowing healthcare providers to be reimbursed for offering assessments on SDOH and HRSNs.

“We have to address these health-related social needs to help women get the mammograms they need,” said CDC Chief Medical Officer Debra Houry, M.D., in a statement. “Identifying these challenges and coordinating efforts between healthcare, social services, community organizations and public health to help address these needs could improve efforts to increase breast cancer screening and ultimately save these tragic losses to families.”

The report was based on a survey of 117,466 women across 39 states and Washington, D.C., representing 82.4% of the total female respondents aged 40-74.