Barriers to mammography screening among US women aged 40 and older: Disparities by race, region, and age

Background: Screening mammography is recommended for women aged 40 years and older. Understanding barriers to screening mammogram and identifying disparate populations is critical for implementing these recommendations equitably. Methods: This cross-sectional study used National Health Interview Survey data from 2021 and 2023. Women aged 40+ who reported not having a mammogram in the past 2 years or ever were included (N=47.9 million weighted). Self-reported reasons were categorized as knowledge/awareness barriers (no reason, didn't know needed, doctor didn't order, no problem), behavioral barriers (put it off, too painful), cost/access barriers (too expensive, no doctor), age-related perceptions (too young/old), and other reasons. Complex survey design examined barrier patterns by race/ethnicity, region, urban-rural status, and age group (P<.05). Results: Overall, knowledge/awareness barriers dominated (58.2%), followed by behavioral (14.0%), other (12.7%), age-related (9.0%), and cost/access barriers (6.2%). Significant disparities existed across race/ethnicity (P<.001), region (P<.001), and age (P<.001), but not urban-rural status (P=.40) (Table). Non-Hispanic Asian women had highest knowledge barriers but lowest cost barriers. Hispanic women had highest cost barriers. Women aged 50-64 had highest behavioral and cost barriers, while women 65+ had minimal cost barriers but high age-related misperceptions. Southern women faced both high knowledge and cost barriers versus other regions. Conclusions: While knowledge and awareness gaps are the primary barriers to mammography screening among US women aged 40 and older, the specific types of barriers vary substantially by race/ethnicity, geographic region, and age. These disparities underscore the need for targeted, population-specific strategies to improve equitable access to mammography screening.