In recent years, mammography rates have plateaued, based on a bi-annual report from the Centers for Disease Control & Prevention (CDC), which also revealed that critical gaps in screening remain for certain racial or ethnic groups, lower socioeconomic groups and the uninsured.
Breast cancer remains the second leading cause of cancer deaths for women in the U.S., and according to the CDC, screening has lowered breast cancer mortality. Every two years, the CDC uses Behavioral Risk Factor Surveillance System (BRFSS) data to estimate U.S. mammography prevalence. Up-to-date mammography prevalence is calculated for women aged 50-74 years who report they had the test in the preceding two years.
In 2008, the BRFSS survey was administered to 414,509 respondents, of whom 120,095 were women aged 50-74 years.
For 2008, overall, age-adjusted, up-to-date mammography prevalence for U.S. women aged 50-74 years was 81.1 percent, compared with 81.5 percent in 2006, CDC reported. Among the lowest prevalences reported were those by women aged 50-59 years (79.9 percent), persons who did not finish high school (72.6 percent), American Indian/Alaska Natives (70.4 percent), those with annual household income less than $15,000 (69.4 percent) and those without health insurance (56.3 percent).
The highest mammography prevalence was among residents of the northeastern U.S., the report found. Throughout the U.S., screening prevalence ranged from 72.1 percent in Nevada to 89.8 percent in Massachusetts. Also, up-to-date mammography screening increased from 77.5 percent in 1997 to 81.1 percent in 2008.
The CDC suggested that the passage of the Patient Protection and Affordability Act “should remove the financial barrier to mammography screening by expanding coverage and eliminating cost sharing in Medicare and private plans; however, barriers remain.” For example, in 2008 the difference in mammography prevalence between women with and without health insurance was 27.5 percent. Even among women with health insurance, 16.2 percent had not received a mammogram in the preceding two years.
The researchers also said that their findings suggest “new roles for public health to improve screening through increased education of women and providers, and through additional targeted outreach to under-screened groups including … uninsured and select minority groups.”
Many factors influence a woman's intent and ability to access screening services, according to the CDC, including socioeconomic status, awareness of the benefits of screening and mammography acceptability and availability. However, the report found that the most common reason women give for not having a mammogram is that no one recommended the test; therefore, healthcare providers have the most important role in increasing the prevalence of up-to-date mammography among women in the U.S.