Purpose: Informed by simulation modeling suggesting that earlier initiation of mammography screening reduces breast cancer mortality disparities, draft US Preventive Services Task Force (USPSTF) guidelines recommend starting biennial mammography screening at age 40. There is conflicting data about screening utilization in Black women compared with White women, particularly in women between the ages of 40-49 years old. Our purpose was to determine the potential impact of screening guidelines (draft USPSTF, current USPSTF, and ACR/SBI) on Black:White mammography screening utilization using nationally representative survey data.
Materials and Methods: CDC National Health Interview Survey (2019) was used to estimate the proportion of female participants (ages 40-74) without breast cancer history reporting mammography screening according to draft USPSTF guidelines (40-74, biennial), existing USPSTF guidelines (50-74, biennial), and ACR/SBI guidelines (40-74, annual), stratified by race (Black vs White). Unadjusted and adjusted logistic regression analyses evaluated the association between race and mammography screening utilization, accounting for complex survey design elements.
Results: 6,390 White and 1,108 Black women were included (weighted sample sizes). Under draft USPSTF criteria, 72.2% of White and 71.8% of Black women reported mammography screening. In our unadjusted analyses, Black women were comparably likely to report undergoing screening (OR 0.98, p=0.847). In our adjusted analyses, Black women were more likely to report undergoing screening (OR 1.42, p=0.01). Under existing USPSTF criteria, 76.0% of White women and 78.6% of Black women reported screening. Under existing ACR/SBI criteria, 55.3% of White women and 56.9% of Black women reported screening. Specifically, evaluating 40-49 year old women, 45.8% of White women and 47.0% of Black women reported screening every year. In our unadjusted analyses, Black women were comparably likely to report undergoing screening (OR 1.04, p=0.741). In our adjusted analyses, Black women were more likely to report undergoing screening (OR 1.51, p=0.02).
Conclusion: In our unadjusted analyses, Black women were comparably likely to report undergoing mammography screening according to draft USPSTF, revised USPSTF, and existing ACR/SBI screening guidelines. In our adjusted analyses, Black women were more likely to report undergoing screening according to USPSTF and ACR/SBI guidelines. Both Black and White women were less likely to undergo mammography screening between the ages of 40-49 years old compared with Black and White women between the ages of 50-74 years old.
Clinical Relevance Statement: Adherence to draft USPSTF and ACR/SBI mammography screening guidelines to reduce breast cancer mortality disparities will require targeted outreach efforts to improve mammography screening percentages in women between the ages of 40-49 years old.
