08 Mammography Uptake Among US Women Aged 40–49: An Andersen Behavioral Model Analysis Using 2019-2023 NHIS Data

Background

Breast cancer remains the most prevalent cancer among US women, with approximately 300,000 new cases expected in 2024. While mammography reduces breast cancer mortality by 20% to 40%, the appropriate screening age for women in their 40s remains debated. Recent 2024 guidelines recommend initiating screening at age 40, yet screening patterns and disparities in this age group remain poorly characterized, particularly following COVID-19 pandemic disruptions.

Objective

To examine mammography screening patterns and disparities among US women aged 40 to 49 years using the Andersen Behavioral Model framework, identifying predisposing, enabling, and need-based determinants of screening uptake from 2019 to 2023.

Materials and Methods

We conducted a cross-sectional analysis of 6774 women aged 40 to 49 years from the National Health Interview Survey (2019, 2021, 2023). The primary outcome was mammography receipt within the past 2 years. Independent variables included predisposing factors (age, race/ethnicity, education), enabling factors (insurance coverage, usual source of care, income, region), and need factors (self-rated health, recent health care utilization). We used survey-weighted analyses to produce nationally representative estimates and examined temporal trends overall and by subgroups.

Results

Overall screening prevalence was 60.3% (95% CI, 58.9%-61.8%), with modest non-significant increase from 60.2% (2019) to 62.2% (2023). Enabling factors showed the strongest associations in insured vs uninsured women (63.8% vs 34.6%, 29%-point gap) and recent doctor visit vs none (63.5% vs 10.3%, 53%-point gap). Race/ethnicity showed significantly different temporal trends (P = .0075). Non-Hispanic Black women improved substantially (59.5% to 71.3%), while Hispanic women declined (61.3% to 54.8%), creating a 16.5%-point disparity by 2023.

Conclusions

Mammography screening among women aged 40 to 49 years remains suboptimal with profound disparities. Enabling factors—particularly insurance and health care access—emerged as primary determinants. The dramatic decline among Hispanic women alongside improvements among Black women reveals widening inequities requiring urgent targeted interventions. Without addressing structural barriers, new screening guidelines may exacerbate existing disparities.