Non-Hispanic Black women had the highest mammography screening rates nationally, while Hispanic and AIAN women, especially in the West, had significantly lower rates (p < 0.001).
Significant ethnoregional disparities exist in breast cancer screening in the U.S., with Hispanic and American Indian/Alaska Native women, particularly in the West, experiencing lower screening rates.
Abstract Background: Despite breast cancer being the most diagnosed cancer among women in the United States, persistent disparities in screening mammography remain. Non-Hispanic Black, Hispanic, and American Indian/Alaska Native (AIAN) women are disproportionately affected by lower screening rates, contributing to delayed diagnoses and worse outcomes. This study aims to examine these disparities through a comprehensive analysis of national prevalence data. Methods: We used 2022 model-based, age-adjusted mammography prevalence data from the Behavioral Risk Factor Surveillance System (BRFSS), based on responses to the core question, “Have you had a mammogram in the past two years?” for women aged 50-74 years. Ethnic groups analyzed included Non-Hispanic White, Hispanic, Non-Hispanic Black, American Indian/Alaska Native (AIAN), and Asian/Pacific Islander (API). U.S. regions were defined using Census Bureau classifications: Northeast, Midwest, South, and West. All ethnic groups were included in descriptive analysis; however, stratified comparisons focused on historically underserved populations (Hispanic, Non-Hispanic Black, and AIAN) due to reliability and consistency of state-level estimates. The dataset comprised 95,728 respondents from all 50 states and D.C.(District of Columbia), with prevalence estimates age-standardized to the 2000 U.S. standard population. States or subgroups with fewer than 50 respondents were excluded. Differences across groups were assessed using Kruskal-Wallis tests and Dunn’s post-hoc comparisons with Bonferroni correction. Results: Stratified inferential analyses emphasized historically underserved populations due to consistency and completeness of data reporting. Statistically significant differences in screening prevalence were found by both ethnicity and region (Kruskal-Wallis p 0.001). Non-Hispanic Black women had the highest screening rates nationally, while Hispanic and AIAN women had significantly lower rates. Regional analysis showed that Hispanic women in the West had markedly lower screening rates than those in the Northeast (adjusted p = 0.03, Dunn’s test). The most pronounced disparities were seen in the West, where both Hispanic and AIAN women were under-screened. In contrast, Non-Hispanic Black women maintained high screening coverage across all regions. The interaction effect between ethnicity and region was evident, with screening gaps varying by both demographic and geographic factors. These findings underscore the need for region- and ethnicity-specific screening interventions, particularly in areas like the Western U.S. where historically marginalized groups remain at elevated risk for under-screening. Conclusion: Improving screening coverage among Hispanic and AIAN populations—especially in underserved regions—will be critical to reducing late-stage diagnoses and improving outcomes. These findings support the urgent need for public health efforts that are community-driven, culturally tailored, and data-informed. As Medicare and Medicaid continue to evolve, proactive investment in regionally customized screening infrastructure, mobile outreach, and language-accessible education can help close persistent gaps. Continued national surveillance and improved data reporting for API and other racial groups are also essential to ensure equitable breast cancer prevention efforts. Further research is needed to understand how regional context influences screening and treatment disparities within the same ethnic populations. Citation Format: S. Goyal, A. Calderon, D. Hernandez, S. Khan, S. Chauhan, D. Nguyen. Ethnoregional Disparities in Breast Cancer Screening: A National Database Analysis abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-12-19.
Goyal et al. (2026) studied this question. Non-Hispanic Black women had the highest mammography screening rates nationally, while Hispanic and AIAN women, especially in the West, had significantly lower rates (p < 0.001).
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