Abstract A015: Small area-estimation for low mammography screening: Geographic and racial disparities in mammography screening, 2015 – 2022
Authors: Howard Sydney P. , Moore Justin X. , Pollard Elinita , Johnson Ryan , Williams Lovoria , Adegboyega Adebola , Chen Jie , Cortes Jorge , James Aimee 
Published: September 2024

Background: Mammography screening is associated with at least a 20% reduction in breast cancer mortality. However, there are racial/ethnic differences in breast cancer mortality. For example, non-Hispanic Black (NHB) women are significantly more likely to die of breast cancer than non-Hispanic White (NHW) women. Few studies have reported small-area estimates for mammography screening among the entire US population; differences by race were either not examined or resulted in mixed findings. The American Cancer Society (ACS) and the United States Preventive Services Taskforce (USPSTF) recommend regular mammography screening from age 40 through 74 years. The current study aims to identify areas of up-to-date mammography screening and to elucidate whether mammography screening varied by geographical location, race, or ethnicity. Methods: Mammography screening within the past 12 months was retrieved from the 2015-2022 Behavioral Risk Factor Surveillance System data. The study population consisted of adult women aged 40 and older residing within the United States. 2020 US census tract population estimates were used to generate gender (all women), race/ethnicity (NHB, NHW, non-Hispanic Asian, and Hispanic/Latina), income, and age group weights for each US census tract. Synthetic estimates of mammography screening uptake at the census tract were conducted using our novel PARIS model (Probability of mammography screening within the past year, given age, race/ethnicity, income, and state) using a multilevel logistic regression model. Regional differences in mammography screening by US Census Bureau regions and divisions were examined. Results: Up-to-date mammography among all women in the sample was 55.98% (SD = 2.07; F (3, 72429) = 2886.81, p &lt; .0001). Mammography screening examined by race indicated the greatest screening rates among non-Hispanic Black women (M = 60.78, SD = 3.11) and least among Asian women (M = 48.68, SD = 3.15). Among four US Census Bureau regions, the West region had the lowest rates of mammography screening among women (M = 54.74, SD = 1.85) while the South region had the highest rates (M = 56.55, SD = 2.18; F(3, 72429) = 2886.81, p &lt; .0001). After further parsing geographical units, the West Pacific region, among the 9 US Census Bureau divisions, had the lowest mammography screening (M = 54.53, SD = 1.81) while the East South Central division had the highest rates of mammography screening (M = 56.94, SD = 2.10; F(8, 72429) = 1360.60, p &lt; .0001).Conclusion: Using novel geospatial methods, the current study elucidated significant differences in mammography screening by race and place. These results suggest that Black women and women living in the South have higher up-to-date mammography screening compared to other women. Thus, the existing inequities in breast cancer outcomes may be explained by differences in the cancer care continuum (delays in follow-up care, treatment, and breast cancer survival). Further examination of the interplay between screening uptake, late-stage diagnosis, and death is needed.

Citation Format: Sydney P. Howard, Justin X. Moore, Elinita Pollard, Ryan Johnson, Lovoria Williams, Adebola Adegboyega, Jie Chen, Jorge Cortes, Aimee James. Small area-estimation for low mammography screening: Geographic and racial disparities in mammography screening, 2015 – 2022 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A015.