Patterns of Breast Cancer Screening and Access to Care in a Safety-Net System

Screening mammography reduces cancer-related mortality by detecting breast cancer at earlier stages. However, variable guidelines and limited access to primary care providers hinder screening uptake. This study characterizes screening mammography uptake patterns prior to breast cancer diagnosis within a safety-net system.

A retrospective study was performed to identify patients diagnosed with new invasive breast cancer between 2018 and 2019 at Parkland Health. Patients were categorized on the basis of screening mammography uptake: never screened (no screening mammography within 5 years of diagnosis), ever screened (last screening mammography between 2 and 5 years prior to diagnosis), and recently screened (screening mammography within 2 years of diagnosis).

The study identified 468 patients with newly diagnosed breast cancer, with 237 (50.6%) never-screened, 113 (24.1%) ever-screened, and 118 (25.2%) recently screened patients. Among 57 women diagnosed at age <40 years, 15 (22.8%) were diagnosed with Stage IV breast cancer, and 24 (42.1%) had a primary care provider at time of diagnosis. Nodal status (p<0.001), tumor size (p<0.001), and stage (p<0.001) correlated with screening mammography uptake behaviors. Patients already established with primary care providers at time of diagnosis were more likely to have early-stage disease (p<0.001).

Half of the patients diagnosed with breast cancer did not have a mammogram within the preceding 5 years. In addition, 131 (27.9%) patients were aged between 40 and 49 years at diagnosis, reflecting the impact of a gap in prior screening guidelines, now addressed in the updated U.S. Preventive Services Task Force guidelines. Connecting patients with primary care providers and engaging in shared decision making may promote screening mammography uptake, especially in vulnerable patient populations.