Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998-2012

Abstract

Objective: To describe the number and proportion of eligible women receiving mammograms funded by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

Methods: Low-income, uninsured, and underinsured women aged 40-64 are eligible for mammography screening through the NBCCEDP. We used data from the NBCCEDP, the Current Population Survey, and Medical Expenditure Panel Survey to describe the number and proportion of women screened by the NBCCEDP and overall.

Results: In 2011 and 2012, the NBCCEDP screened 549,043 women aged 40-64, an estimated 10.6 % (90 % confidence interval [CI] 10.4-10.9 %) of the eligible population. We estimate that 30.6 % (90 % CI 26.4-34.8 %) of eligible women aged 40-64 were screened outside the NBCCEDP, and 58.8 % (90 % CI 54.6-63.0 %) were not screened. The proportion of eligible women screened by the NBCCEDP varied across states, with an estimated range of 3.2 % (90 % CI 2.9-3.5 %) to 52.8 % (90 % CI 36.1-69.6 %) and a median of 13.7 % (90 % CI 11.0-16.4 %). The estimated proportion of eligible women aged 40-64 who received mammograms through the NBCCEDP was relatively constant over time, 11.1 % (90 % CI 10.2-11.9 %) in 1998-1999 and 10.6 % (90 % CI 10.4-11.9 %) in 2011-2012 (p = 0.23), even as the number of women screened increased from 343,692 to 549,043.

Conclusions: Although the NBCCEDP provided screening services to over a half million low-income uninsured women for mammography, it served a small percentage of those eligible. The majority of low-income, uninsured women were not screened.

Fig. 1

Percentage of low-income uninsured women screened for breast cancer in the USA, 2011–2012. Source: Authors’ tabulations of modified data from Medical Expenditure Panel Survey 2011, US Census Bureau, Current Population Survey, 2011–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data

Fig. 2

Percent of NBCCEDP-eligible women screened for breast cancer by state and District of Columbia compared to national average, 2011–2012. Source: Authors’ tabulations of modified data from the US Census Bureau, Current Population Survey, 2011–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data. Notes: The symbols show the percentage of eligible women screened by each state and District of Columbia. Two states that used different eligibility/implementation criteria are not included. Data points for each age-group sorted by percentage of eligible women screened. The proportion of women screened by the NBCCEDP across the USA is 10.6 % aged 40–64 and 17.3 % aged 50–64

Fig. 3

Trends in NBCCEDP-eligible population and reach for breast cancer screening by age-group. Source: Authors’ tabulations of modified data from the US Census Bureau, Current Population Survey, 2011–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data. Note: The numbers and percentages in the shaded region of the graph are interpolated values

Fig. 4

NBCCEDP trends in the percent of eligible women screened for breast cancer, aged 50–64, by race and ethnicity^a. Source: Authors’ tabulations of modified data from the US Census Bureau, Current Population Survey, 2011–2012 Annual Social and Economic Supplements, and from NBCCEDP October 2013 data. Notes: AIAN American Indian or Alaska Native; ANHOPI Asian American, Native Hawaiian, or Pacific Islander. Highest and lowest points are marked to point out scale