Mammography Among Utah Women

Breast cancer is the second leading cause of cancer death for women in the United States, and the leading cause of cancer death for women in Utah. One in eight women in the US will develop breast cancer in her lifetime.

Utah is among the three lowest states for mammography screening rates in women aged 40 years and older, despite the research that shows a mammography reduces breast cancer mortality and is a critical screening tool that can increase the chance of early detection and treatment.

In May 2023, the Utah Women & Leadership Project (UWLP) updated its research snapshot titled, Mammography Among Utah Women: A 2023 Update. Thanks to the report authors, Dr. Chloe Bhowmick and Sadie Wilde.

Mammography has?helped reduce breast cancer mortality in the U.S. by nearly 40% since 1990. Studies show that mammography screening cuts the risk of dying from breast cancer nearly in half. Interesting, three out of four women diagnosed with breast cancer have no family history of the disease and are not considered high risk.

Despite the advantages of annual mammography screening, many Utah women do not get screened. According to the Utah Department of Health and Human Services , Utah did not meet its goal of 76.0% of Utah women aged 40 or older being screened for breast cancer by 2020. Only 62.7% of Utah women in this age group reported having a mammogram in the last two years. In comparison, the average screening rate for US women in the same group was 69.0%.?

By the Numbers

Interesting, breast cancer incidence rates are lower in Utah (113.3 per 100,000 in 2020) than in the US (129.7 per 100,000 in 2019)—we do have a younger population. Regarding mammography, the rate of Utah women aged 40 years or older who reported receiving a mammogram in the last two years increased from 1989 (51.6%) to 2008 (66.4%). Several factors may be associated with mammography screening rates:

• Age: From 2019 to 2020, women aged 40 to 49 were significantly less likely to have received a mammogram compared to women in older age groups.
• Ethnicity/Race:? From 2018 to 2020, White women (62.8%) had the lowest mammography rates compared to other races.?The largest change from the previous report is that screening rates of American Indian/ Native Alaskan women increased 10.9%.
• Income & Education: Higher income and higher education are both associated with higher mammography rates.?
• Location:? Summit reported the highest mammography rates (69.5%), and TriCounty (Duchesne, Uintah, and Daggett) reported the lowest rates (47.2%).
• Utah Cancer Survivors:?For those age-eligible for breast cancer screening, 74.4% had gotten a mammogram in the last two years.?

Contributing Factors to Non-Adherence

The following factors and additional barriers affecting women’s likelihood of scheduling regular mammograms:

• Insurance Coverage and Financial Concerns: In 2014, approximately 14.1% of Utah adults were unable to receive needed healthcare in the previous year due to cost. This percentage decreased to 10.3% in 2020, which is slightly below the national average of 11.2% in the same year.
• Income:?Women with higher income levels were more likely to identify forgetting to schedule an appointment or lack of time as a barrier, while women with lower income cited financial difficulty and a lack of screening recommendation from a physician as more common barriers.
• Mammography Guidelines: A discrepancy between mammography guidelines may be another factor that contributes to non-adherence, as Utah women aged 40 to 49 have a significantly lower screening rate than older Utah women.
• Other: Other factors to consider include lack of transportation and geographic accessibility, cultural norms, prioritizing work and family obligations, lack of childcare for the appointment, lack of knowledge about mammography, lack of trust in the health care system, concern of pain during the screening, and fear of receiving a diagnosis.

Increasing Mammography Rates

Utah’s breast cancer screening rate is 6.3% below the national average. State and local systems can take several steps to increase mammography rates:

1. Establish clear, consistent guidelines and goals.
2. Utah policymakers and healthcare leaders to regularly assess and address logistical, structural, and financial barriers to cancer screenings.
3. Utah healthcare and insurance systems can help increase cancer screening rates by building patient advisories into electronic record systems.
4. Employers can help increase mammography and other cancer screening rates by implementing initiatives (e.g., wellness programs) and policies (e.g., worktime flexibility) that encourage employees to complete screenings according to recommended age and frequency guidelines.
5. Increase food security in the state and create healthy neighborhood environments.
6. Improve access to high-quality healthcare services for all.
7. Reduce financial toxicity among cancer survivors.

Conclusion

Education and advocacy from community groups can help Utah women receive this valuable screening test at higher rates. Improved access to mammography and other key healthcare resources will strengthen the positive impact of women throughout the state.

To learn more about mammography among Utah women,?read the full research snapshot. Also, A Bolder Way Forward has a Health Across the Lifespan spoke and increasing preventative healthcare and screenings are a critical part of ensuring that more Utah women thrive.

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Dr. Susan R. Madsen is a global thought leader, author, speaker, and scholar on the topic of women and leadership. She is also the Karen Haight Huntsman Endowed Professor of Leadership in the Jon M. Huntsman School of Business at Utah State University and the Founding Director of the Utah Women & Leadership Project. Thank you to co-authors Dr. Chloe Bhowmick and Sadie Wilde.

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