ASO Author Reflections: Breast Cancer Screening in the Safety-Net: Trying to Close the Gap When the Fault Lines Go Deep

Excerpt

The United States’ (U.S.) fragmented health care system and the structural racism and class inequalities inherent in its societal framework have long contributed to health disparities within its population. In a sobering analysis of U.S. inequalities from the 1960s to 2000, Satcher et al.1 showed that while the U.S. made some progress in decreasing the Black–White gap in civil rights, housing, education, and income, health inequalities did not budge during the same timeframe. While mammographic screening increased among all women in the U.S. from 33% in 1990 to 73% in 2018, screening mammography rates among uninsured women in the U.S. in 2018 remained abysmally low at 39%.2 Mirroring this lack of progress among a small but significant segment of the American society, we found that our safety-net hospital’s screening rates in 2018–2019 for women over the age of 50 who had a primary care medical home was only 42%. Previously, we noted a three-fold higher rate of late-stage breast cancers at presentation among women accessing our safety-net hospital compared with women accessing other Commission-on-Cancer accredited centers across the country—with direct implications for decreased survival and more aggressive treatment among this disadvantaged group—and found a lack of screening mammography to be the most significant factor associated with this late stage at presentation.3 We thus set out to see whether we could increase mammography uptake among women accessing our safety-net. …