Black Women Lack Access to Newer Mammogram Technology
Among people with Medicare, Black women had less access to newer mammogram technology than white women — even when they had mammograms at the same place — according to a study.
The research was published online on Oct. 11, 2022, by the journal Radiology. Read the abstract of “Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare Insurance.”
Mammogram technology
There are two main types of mammogram technology:
3D mammograms, also called digital breast tomosynthesis, digital tomosynthesis, or just tomosynthesis
2D digital mammograms
A 3D mammogram is new technology that creates a three-dimensional image of each breast using several X-ray images taken at different angles around the breast.
A 2D digital mammogram creates a two-dimensional image of each breast using two X-ray images taken from the side and the front of each breast.
The U.S. Food and Drug Administration (FDA) approved 3D mammography in 2011 and it is now the standard of care for breast cancer screening. Still, 3D mammography may not be available at all hospitals and mammogram facilities.
According to statistics from the FDA from Nov. 1, 2022, about 84% of U.S. screening facilities offer 3D mammograms in at least one of their mammography units, but fewer than half of all accredited units are actually 3D-capable.
Before the year 2000, mammograms were done with film. These were called screen-film mammograms. X-rays were beamed through the breast to a sheet of black-and-white film, which was developed.
About the study
The researchers looked at 4,028,696 mammography claims between January 2005 and December 2020 from women ages 40 to 89 who had Medicare fee-for-service insurance:
the women’s average age was 72
9% of the women were Black
38% of the women lived in areas with a per capita income of less than $30,000
72% of the women lived in metropolitan areas
According to the researchers, Medicare reimbursement to providers is 1.2 to 1.8 times lower than that of private insurers, which may contribute to inequities in care.
Between 2005 and 2016, the proportion of women receiving digital mammograms versus film-screen mammograms increased from 10% to 98%.
The difference between Black women and white women who had digital mammograms was highest in 2010, and decreased from 4.7 percentage points that same year to 1.5 percentage points in 2016 as digital mammograms became available almost everywhere.
The researchers also looked at differences in mammogram technology by income and area of residence.
The difference between women with incomes of $50,000 and higher and women with incomes of less than $30,000 who had digital mammograms was highest in 2008, and decreased from 23.9 percentage points that same year to 2.4 percentage points in 2016.
The difference between women living in metropolitan areas and women living in small or rural areas who had digital mammograms was highest in 2008, and decreased from 29.2 percentage points that same year to 2.9 percentage points in 2016.
The researchers then looked at differences in 2D digital mammograms and 3D mammograms between 2015 and 2020.
The difference between Black women and white women who had 3D mammograms was highest in 2018 — 10.8 percentage points.
The researchers also looked at differences at individual facilities. Until 2009, within a facility, Black women were more likely than white women to have a film-screen mammogram instead of a 2D digital mammogram. From 2015 to 2020, Black women were less likely to have a 3D mammogram than white women.
“Current reimbursement contributes to inequity because locating new technology in facilities that serve patients with public insurance, Medicare, and Medicaid, is not economically sustainable,” co-author Eric W. Christensen, PhD, said in a statement. Dr. Christensen is principal research scientist in health economics for the Harvey L. Neiman Health Policy Institute and adjunct professor of health services management at the University of Minnesota. “The Centers for Medicare and Medicaid Services can create economic incentives to lessen disparities through reimbursement that is either comparable to private payers or that more directly incentivizes adoption of newer technology in underserved communities.”
What this means for you
Although very troubling, the results of this study show that racial differences in access to newer mammogram technology are narrowing.
Your race, ethnicity, education level, or income level should never affect the quality of care you receive. Every woman should have access to the best care possible, including 3D mammograms, which are the standard of care.
It makes sense to call your facility to check whether it offers 3D mammograms before you make your appointment. If the facility doesn’t offer 3D mammograms, ask your doctor to recommend a facility that does.
In some states, such as Washington, there are laws that require facilities not to charge more for 3D mammograms. So even if your health insurance doesn’t cover it, you can still get a 3D mammogram for the cost of a 2D mammogram, which in almost all states is free. In other states, such as New Jersey and Pennsylvania, there are laws that require health insurers to cover 3D mammograms at no cost to women.
If you aren’t sure whether your health plan covers 3D mammograms, call and ask. Both Medicare and Medicaid cover 3D mammograms.
You also may want to call the facility to ask how much, if anything, you might have to pay out of pocket for a 3D mammogram.
Learn more about the different types of mammograms.
— Last updated on April 10, 2025 at 2:01 PM