Differences in mammographic screening among women 40-49 years old by race/ethnicity, socioeconomic status, and region in the United States.

Abstract

e18593 Background: The recommended age to initiate screening mammograms in non-high-risk women varies amongst governing bodies in the United States (US) and now ranges from 40 to 50 years old. As a result, mammography among women aged 40-49 represents an area of uncertainty and discretion for patients and providers. Whether mammography in this age group is equitably targeted is uncertain. We aimed to identify factors associated with breast cancer screening among women aged 40-49 in the US. Methods: We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual nationally representative telephone survey of American adults. We included women aged 40-49 (and, for comparison, 50-59) who reported no personal history of breast cancer. In total, 154,860 women (aged 40-49, n = 62,158; aged 50-59, n = 92,702) were included from 2016 and 2018; mammography was not routinely queried in 2017 or 2019, and COVID-19 interrupted screening in 2020. Women who reported having a mammogram in the past one to two years were considered to have a recent mammogram. Using STATA 15, we used logistic regression to estimate weighted adjusted odds ratios (OR) and 95% confidence intervals (CI) of recent mammography associated with age, race, geographic region, and cost as a barrier to healthcare. Results: A total of 62% (95% CI = 61-63%) of surveyed women aged 40-49 reported a recent mammogram. This population had expectedly lower odds of being screened compared to women aged 50-59 (OR = 0.51, 95% CI = 0.48-0.53, p < 0.001). Compared to White women 40-49 years old, Black (OR = 1.37, 95% CI = 1.22-1.50, p < 0.001) and Hispanic (OR = 1.17, 95% CI = 1.04-1.32, p = 0.01) women had higher odds of reporting a recent mammogram. Women living in the South (OR = 0.85, 95% CI = 0.76-0.94, p = 0.004) or West (OR = 0.67, 95% CI = 0.60-0.76, p < 0.001) were less likely to have a recent mammogram compared to the Northeast. Women reporting cost as a barrier to accessing medical care were less likely to report a recent mammogram (OR = 0.52, 95% CI = 0.48-0.58, p < 0.001). Conclusions: In this nationally representative analysis of women aged 40-49, Black and Hispanic women were more likely to report breast cancer screening than White women. This evidence contrasts prior work showing that Black and Hispanic women historically had lower rates of mammography. The results of this study encouragingly suggest that women of color may be initiating screening at younger ages. Poverty is a poor prognostic factor for breast cancer, and cost appeared to serve as a major barrier to mammography. The substantial degree of geographic heterogeneity underscores established variation in how medical resources are distributed and used in the US. Our results provide a benchmark for future studies of interventions at the patient, provider, and systems levels to ensure equitable, cost-effective and broad-based use of mammography nationwide.