Breast Cancer Screening in Montana

Montana

Breast cancer is the second-leading cause of cancer deaths among women in the United States. Breast cancer screening can help reduce the risk of death by detecting breast cancer early, when there are more treatment options. 

A mammogram is a low-dose x-ray procedure used to detect breast cancer. Screening mammograms can pick up tiny tumors or microcalcifications that may be precursors to breast cancer before there are any outward signs or symptoms of the disease. More detailed diagnostic mammograms are used to evaluate patients presenting with a lump or other symptoms of breast cancer. Since their peak in 1989, breast cancer deaths have declined more than 40%, due mainly to mammography screening efforts.

According to America’s Health Rankings data, the prevalence of breast cancer screening is higher among:

• Black women compared with women of all other racial and ethnic groups.
• College graduates compared with those with less than a high school education.
• Women with an annual household income of $75,000 or more compared with those with incomes less than $25,000.
• Women living in metropolitan areas compared with women in non-metropolitan areas.
• Women without a disability compared with women who have independent living difficulties.
• Straight women compared with LGBQ+ women.

In 2023, the United States Preventive Services Task Force (USPSTF) updated their recommendations for breast cancer screening to start at age 40, instead of 50, with continued screening every other year. This expansion of the prior recommendation is informed by recent and more inclusive breast cancer research on younger populations. When considering older populations, however, current evidence remains insufficient to assess if the benefits of mammography outweigh the harms for women ages 75 and over. 

The Community Guide lists several interventions that have proven effective at increasing breast cancer screening, including:

• Use of community health workers to improve awareness and education around breast cancer screenings and assist with client reminders, appointment scheduling and navigating other barriers to access.
• Multicomponent interventions, which combine two or more evidence-based approaches and/or interventions to reduce structural barriers (such as reducing administrative barriers, assisting with appointment scheduling, addressing transportation barriers or offering child care). 
• Patient navigation services such as client reminders and financial support to reduce out-of-pocket costs, particularly among historically disadvantaged racial/ethnic populations and people with lower incomes. 

Targeted interventions are needed as well to address the significant racial disparities in breast cancer rates and outcomes. Black women experience more aggressive cancers at younger ages, and are approximately 40% more likely to die from breast cancer compared with white women. Research indicates that Black women are being deprioritized and let down at every step of the process: On average, Black women receive lower-quality screening services, wait longer for their results, and are less likely to be treated with targeted therapies or surgical interventions. Improving communication and collaboration between community organizations, advocacy groups and different elements of the health care system is critical to reducing these gaps in care. 

Additionally, increasing access to health care through Medicaid expansion improves both overall health outcomes and health equity. A 2020 study of the Affordable Care Act found that states that expanded Medicaid had larger reductions in their percentage of uninsured patients and advanced-stage cancer cases compared with non expansion states, with the largest benefits among Black patients.

Healthy People 2030 has several objectives regarding cancer screenings, including:

• Increasing the proportion of females screened for breast cancer. 
• Increasing the proportion of females with a family history of cancer who get genetic counseling for breast and/or ovarian cancer.

American Cancer Society. “Cancer Facts & Figures 2023.” Atlanta, GA: American Cancer Society, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.pdf.

Giaquinto, Angela N., Hyuna Sung, Kimberly D. Miller, Joan L. Kramer, Lisa A. Newman, Adair Minihan, Ahmedin Jemal, and Rebecca L. Siegel. “Breast Cancer Statistics, 2022.” CA: A Cancer Journal for Clinicians 72, no. 6 (November 2022): 524–41. https://doi.org/10.3322/caac.21754.

Le Blanc, Justin M., Danielle R. Heller, Ann Friedrich, Donald R. Lannin, and Tristen S. Park. “Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis.” JAMA Surgery 155, no. 8 (August 1, 2020): 752. https://doi.org/10.1001/jamasurg.2020.1495.