Improving mammography utilization to cut breast cancer mortality

April 23, 2024 - A recent report from the Centers for Disease Control and Prevention (CDC) highlights the association between mammography utilization and various social determinants of health (SDOH) and health-related social needs among women in the United States. The study utilized data from the 2022 Behavioral Risk Factor Surveillance System to analyze mammography use among women aged 40–74. 

Breast cancer remains a significant public health challenge in the US, claiming approximately 40,000 lives each year. While mortality rates have declined, disparities persist, particularly affecting non-Hispanic Black or African American women and those with low incomes. Mammography, a vital tool in early detection, is recommended to reduce breast cancer deaths. However, access to this life-saving screening tool is not equitable across all populations due to adverse SDOH and health-related social needs (HRSNs). 

Key Findings 

The CDC’s Vital Signs: Mammography Use and Association with Social Determinants of Health and Health-Related Social Needs Among Women — United States, 2022 report found that mammography utilization decreased with increasing adverse SDOH and HRSNs. Factors such as social isolation, life dissatisfaction, lost or reduced employment hours, receipt of food stamps, lack of reliable transportation, and cost as a barrier to healthcare access were strongly associated with decreased mammography use. 

Among women aged 50–74, mammography prevalence was significantly lower for those experiencing three or more adverse SDOH and HRSNs than those with none. The prevalence of mammography use during the previous two years ranged from 64.0% to 85.5% among women aged 50–74 across different states. Mammography use among women aged 40–49 was significantly lower than among those aged 50–74 in most states. 

Black women reported the highest prevalence of mammography use within the previous two years, with rates of 65.2% and 82.9% among women aged 40–49 years and 50–74 years, respectively. Mammography use also increased with higher income and educational attainment levels. 

Implications for Public Health Practice 

Addressing SDOH is vital to improving healthcare access and outcomes for all individuals — particularly in mammography utilization and breast cancer prevention. The CDC report underscores the importance of a multifaceted approach beyond traditional healthcare delivery to tackle the underlying social and economic factors influencing health outcomes. 

Initiatives such as the SDOH playbook and the Centers for Medicare & Medicaid Services (CMS) implementation of new billing codes signal progress in integrating SDOH and HRSN assessments into clinical practice. These efforts aim to incentivize healthcare providers to proactively identify and address the social barriers that hinder access to mammography and other preventive services. 

Furthermore, community-based interventions are crucial in addressing SDOH and HRSNs at the grassroots level. Programs that provide healthy food options, facilitate access to transportation, offer social support networks, and address housing instability can significantly impact healthcare adherence and improve health outcomes. By collaborating with community organizations, healthcare providers can leverage existing resources and networks to reach underserved populations and mitigate the disparities in mammography utilization. 

The CDC report underscores the need for ongoing collaboration among healthcare providers, social services, community organizations, and public health programs to develop comprehensive strategies that address the diverse social needs of women across different demographic groups. By adopting a holistic approach that considers social, economic, and environmental factors, stakeholders can work together to create more equitable healthcare systems and improve breast cancer outcomes. 

Limitations and Future Directions 

While the CDC report's findings provide valuable insights into the association between SDOH and mammography utilization, several limitations exist. 

First, relying on self-reported data from the Behavioral Risk Factor Surveillance System may introduce bias and inaccuracies in reporting mammography utilization. Additionally, the inability to distinguish between screening and diagnostic mammograms in the survey data may lead to overestimating up-to-date mammography use per screening recommendations. 

Also, the limited generalizability of the findings due to response rates and the exclusion of certain demographic groups from the analysis poses challenges in extrapolating the results to the broader population. Future research should address these limitations by employing more rigorous study designs and methodologies to capture a more representative sample of women across diverse sociodemographic backgrounds. 

Longitudinal studies are needed to examine the long-term impact of interventions targeting SDOH on mammography utilization and breast cancer outcomes. By tracking changes in mammography rates over time and assessing the effectiveness of interventions in addressing social barriers to healthcare access, researchers can inform the development of evidence-based policies and programs to reduce breast cancer mortality. 

Although the CDC report offers valuable insights into the intricate interplay of SDOH and mammography utilization, additional research is necessary to tackle the constraints and knowledge deficiencies. By deepening comprehension of the obstacles to preventive care and deploying focused interventions, the healthcare sector can make strides toward attaining health equity and diminishing disparities in breast cancer outcomes.