Breast cancer is the most commonly diagnosed cancer among women in the U.S. An estimated 230,000 new cases of breast cancer will be diagnosed this year, and there are about 2.5 million women breast cancer survivors in the U.S. In recognition of October as National Breast Cancer Awareness Month, this article focuses on mammogram and clinical breast exam screenings, as well as access to care among women in Southeastern Pennsylvania.

The following article presents data from PHMC’s 2010 Southeastern Pennsylvania Household Health Survey, which is a Random Digit Dial landline and cell phone telephone survey conducted every two years with 10,000 households in the five-county Southeastern Pennsylvania (SEPA) region of Bucks, Chester, Delaware, Montgomery, and Philadelphia Counties.

Mammogram and Clinical Breast Exam Screenings

The American Cancer Society suggests that around the age of 40, women should have an annual mammogram and that around the age of 18, women should have a clinical breast exam every one to three years.

• While the best way to detect breast cancer in its early stages is through an annual mammogram, in SEPA, more than one-third of women 40 years or older (34.6%) has not had a mammogram in the past year, representing approximately 370,200 women 40 years or older in the region.

• Approximately one in 16 women 40 years or older (6.4%) never had a mammogram, representing 68,000 women in the region.

• About one-third of women 18 years of age or older (30.1%) did not have a clinical breast examination within the past year, representing about 478,000 women in the SEPA region.

• One in 20 women 18 years or older (5.4%) never had a clinical breast exam, representing 86,100 women in the region.

• Two in five women 75 years or older (39.1%) have not had a mammogram within the past year, followed by 38.8% of women 40-49 years, 34.1% of women 50-59 years, and 28.7% of women 60-74 years.

• For clinical breast examinations, 36.3% of women 75 years or older have not had an exam in the past year, followed by 31.8% of women 18-39 years, 29.3% of women 50-59 years, 26.8% of women 60-74 years, and 27.7% of women 40-49 years.

• There are also screening disparities by educational attainment (Figure 1). About two in five women with less than a high school diploma (39.9%) have not had a mammogram in the past year, compared with 36.4% of women with a high school diploma, 37.3% of women with some college, 31.5% of women with college degrees, and 29.0% of women with a post college education.

• For clinical breast exams, 43.5% of women with less than a high school diploma have not had an exam in the past year, compared with 34.4% of women with a high school diploma, 31.3% of women with some college, 25.8% of women with a college degree, and 20.2% of women with post-college education (Figure 1).

• Screening disparities are evident by race/ethnicity as well. Latina women are the most likely racial/ethnic group (40.9%) to have not had a mammogram in the past year, followed by White (35.1%), Asian (32.1%), and Black (30.7%) women.

• For clinical breast exams, 45.5% of Latina women have not had a clinical breast exam in the past year compared with Asian (35.7%), White (29.7%), and Black (25.9%) women.

• Over two-fifths of women living below 150% of the Federal Poverty Level (42.6%) have not had a mammogram in the past year compared with 32.6% of women living at or above the poverty level.

• Similarly, 39.0% of women living under the poverty line have not had a clinical breast exam in the past year compared to 27.6% of women at or above the poverty line.

Access to Care

Barriers to receiving breast examinations and mammograms include regular access to care and health insurance. Women in the SEPA region are less likely to receive a mammogram or breast examination if they have difficulty accessing care due to lacking health insurance or not having a regular source of care.

• More than one-half of women without a regular source of care (52.8%) have not had a mammogram within the past year compared with one-third of women with a regular source of care (33.6%) (Figure 2).

• Similarly, for women without health insurance, 64.0% have not had a mammogram within the past year compared with 33.0% of women with health insurance (Figure 2).

• Nearly one-half of women with no regular source of care (46.0%) have not had a clinical breast exam in the past year compared with 28.7% of women with a regular source.

• Additionally, more than one-half of women without health insurance (58.1%) have not had a clinical breast exam in the past year compared with insured women (27.5%).

Conclusion

In Southeastern Pennsylvania, breast cancer screening disparities have been found by age, educational attainment, race/ethnicity, and poverty level. Additionally, women who do not have a regular source of care or health insurance are more likely to have not had a screening within the past year compared with their counterparts. Several organizations in the area offer free or low-cost screening services, including the Philadelphia Department of Public Health.

For more information about the findings presented in this article, please contact Nicole Dreisbach at nicoled@phmc.org.

For more information about national breast cancer statistics, please visit the American Cancer Society at: http://www.cancer.org/cancer/breastcancer/index.