Racial Disparities in Breast Cancer Screening Persist Despite Increased Insurance Coverage

A new study by researchers at the University of Pennsylvania has highlighted the persistent racial disparities in breast cancer screening, despite increased insurance coverage for supplemental screening. The study, which analyzed data from over 68,000 women undergoing mammography screening between 2015 and 2021, found that Black women were less likely to meet the eligibility criteria for supplemental screening due to lower breast density and lifetime risk estimates. This finding suggests that the current breast density criteria for magnetic resonance imaging may not accurately reflect breast cancer risk in Black women.

Key Takeaways:

• The study included 68,478 women, with 38,397 Black women and 30,081 White women, aged 40 to 74 years, without prior breast cancer or known BRCA1/2 variants.
• Fewer Black women had extremely dense breasts (561 [2.1%] vs 1464 [5.8%]; P = .02) and greater than 20% lifetime risk of breast cancer identified (257 [0.7%] vs 1905 [6.4%]; P = .04) compared with White women.
• Consequently, Black women were less likely to meet the eligibility criteria for supplemental screening (523 [1.6%] vs 2081 [8.4%]; P = .02).
• The criteria showed lower sensitivity but higher specificity for detecting false-negative mammograms in Black compared with White women in one round of screening.
• Using heterogeneously or extremely dense breasts alone would detect more false negatives but with significantly more women recommended for magnetic resonance imaging.

Statistics:

• 2.1% of Black women had extremely dense breasts compared to 5.8% of White women.
• 0.7% of Black women had greater than 20% lifetime risk of breast cancer identified compared to 6.4% of White women.
• 1.6% of Black women met the eligibility criteria for supplemental screening compared to 8.4% of White women.
• The sensitivity of the criteria for detecting false-negative mammograms was lower in Black women compared to White women.
• Using the current breast density criteria for magnetic resonance imaging may not accurately reflect breast cancer risk in Black women.

Sources:

• "Racial Differences In Screening Eligibility By Breast Density After State-level Insurance Expansion" (JAMA Network Open, 2025;8(8), doi: 10.1001/jamanetworkopen.2025.28835).
• University of Pennsylvania, "New Findings on Breast Cancer Screening Described by Investigators at University of Pennsylvania" (Medical Imaging Law Weekly, October 28, 2025; p 65).
• American Cancer Society, Susan G. Komen Breast Cancer Foundation, Basser Center for BRCA, Breast Cancer Research Foundation, National Institutes of Health (NIH) - USA.
• University of Pennsylvania, Perelman School of Medicine, Dept Biostat Epidemiol & Informat, Philadelphia, PA, United States.