Mammography Among Utah Women: A 2023 Update

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 the state of Utah. One in eight women in the US will develop breast cancer in her lifetime. Mammography has been shown to reduce breast cancer mortality and thus is a critical screening tool that can increase the chance of early detection and treatment.

However, despite the advantages of mammography screening, not all women receive screenings according to recommended guidelines. 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. Data from the latest Behavioral Risk Factor Surveillance System (BRFSS) survey placed Utah among the three lowest states for breast cancer screening rates in women aged 40 years or older.  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%. 

This brief includes new data from the Utah Department of Health’s Public Indicator Based Information System (IBIS) and the 2020 BRFSS Survey; it also highlights the Utah Cancer Action Network’s (UCAN) current strategic plan and target goals. The snapshot presents three significant areas:

1.  An overview of breast cancer and mammography rates for women in Utah, including various demographic factors,
2. An analysis of some of the issues contributing to lower breast cancer screening rates in Utah, and
3. A discussion of what Utahns can do to improve mammography rates, with links to relevant resources.

Mammography by the Numbers

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). 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, including age, ethnicity and race, income, and education.

• 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 & higher education are both associated with higher mammography rates. 
• Location:  Summit reported the highest mammography rates (69.5%), and TriCounty 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. 

Factors Contributing to Non-Adherence

The 2017 snapshot identified numerous reasons why Utah women may not adhere to screening recommendations, including time constraints, family size, education, level of health literacy, and lack of a primary care provider. These factors are still relevant in 2023, and additional barriers affecting women’s likelihood of scheduling regular mammograms appear below.

• 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.
• COVID-19: Medical centers may have struggled to manage the backlog of mammography appointments during the rebound, further delaying preventative services. Overall, the pandemic may cause subtle but lingering effects on mammography rates.
• 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.

What Utahns Can Do

Utah’s breast cancer screening rate is currently 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

Although mammography is widely recognized as an important tool in the fight against breast cancer, Utah remains
one of the lowest-ranking states for mammography screening. Education and advocacy from community groups can
help age-eligible 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 snapshot.