On Disparities in Breast Cancer Screening

An Analysis of Behavioral Risk Factor Surveillance Survey Data related to Racial/ Ethnic characteristics





mammography screening, breast cancer, race/ethnicity, sexual and gender minority, females assigned at birth


Background. Despite the death rates of breast cancer declining in the last two decades, new breast cancer cases have disproportionately affected some marginalized populations such as African American women. Since mammography screening disparities by sexual orientation and gender identity are inconsistent, it is important to understand the patterns of mammography screening to inform public health interventions.

Aims. This secondary data analysis study aimed to examine the disparities in mammography screening by sexual orientation and gender identity among females assigned at birth (FAAB) overall and stratified by race/ethnicity in the U.S.

Methods. By using 2014, 2016, and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) data, we conducted adjusted multivariable logistic regression models to estimate the odds of receiving an up-to-date mammography screening in relation to sexual orientation, gender identity, and other correlates among FAAB aged 50-74 years (unweighted N=228,257).

Results. Overall, the lifetime and up-to-date prevalence of mammography screening were 96.3% and 76.0% in U.S. FAAB, respectively. Non-Hispanic Black (NHB) participants reported a higher rate of up-to-date mammography screening (84.13%) whereas those who had an income less than $15,000 per year had the lowest (71.31%). Being insured, overweight/obese, and not a current smoker were positively associated with receiving an up-to-date mammography screening across racial and ethnic groups. Besides, being physically active was significant for an up-to-date mammography screening in non-Hispanic White (NHW) and Hispanic participants. Also, Hispanic transgender participants were more likely to have an up-to-date mammography screening than their same-ethnic cisgender counterparts.

Contribution to Evidence-Based Care. The findings reveal that the disparities in receiving an up-to-date mammography screening varied by sexual identity, gender identity, and race/ethnicity in FAAB aged 50-74 years. The lower rate of an up-to-date mammography screening was found particularly in Hispanic, bisexual AFAB. Future tailored mammogram programs should integrate physical activity and cultural components for people with multiple minority identities. 

Author Biographies

Changhui Song, Henan Normal University, Xinxiang, Henan Province, China

Changhui Song received his Ph.D. in Gender and Development Studies from the Asian Institute of Technology in Thailand. He currently works as Assistant Professor at Social Affairs College, Henan Normal University in China. He is a qualitative researcher who specializes in gender and sexuality.

Hui Xie, Joseph J. Ziller College of Public Health, University of Wisconsin-Milwaukee, WI, USA

Hui Xie is a Ph.D. candidate at the University of Wisconsin-Milwaukee. Hui has been involved in many studies addressing health disparities in underserved populations, including sexual and gender minorities, racial minorities, immigrant populations, and people in incarceration across the world. Hui is a quantitative researcher by training; she has collaborated with qualitative scholars to develop substantial skills to collect and analyze qualitative narratives.


Administration for Community Living. (2020). U.S. Department of Health and Human Services. 2019 Profile of Older Americans. Retrieved October 16 2022, from: https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2019ProfileOlderAmericans508.pdf

Agénor, M., Pérez, A. E., Tabaac, A. R., Bond, K. T., Charlton, B. M., Bowen, D. J., & Austin, S. B. (2020). Sexual Orientation Identity Disparities in Mammography Among White, Black, and Latina US Women. LGBT Health, 7(6), 312-320. https://doi.org/10.1089/lgbt.2020.0039 DOI: https://doi.org/10.1089/lgbt.2020.0039

Amirikia, K. C., Mills, P., Bush, J., & Newman, L. A. (2011). Higher population‐based incidence rates of triple‐negative breast cancer among young African‐American women: implications for breast cancer screening recommendations. Cancer, 117(12):2747-53. https://doi.org/10.1002/cncr.25862 DOI: https://doi.org/10.1002/cncr.25862

American Cancer Society a. (2020). Cancer Prevention & Early Detection: Facts & Figures 2020. Retrieved October 16 2022, from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-prevention-and-early-detection-facts-and-figures/cancer-prevention-and-early-detection-facts-and-figures-2019-2020.pdf

American Cancer Society b. (2020). Lesbian, gay, bisexual, transgender, queer (LGBTQ) people with cancer fact sheet. Retrieved October 16 2022, from: https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets-flyers/lgbtq-people-with-cancer-fact-sheet.pdf

Ashing-Giwa, K. T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., Clayton, S., Williams, I, & Hills, D. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology, 13(6): 408-28. https://doi.org/10.1002/pon.750 DOI: https://doi.org/10.1002/pon.750

Austin, L. T., Ahmad, F., McNally, M. J., & Stewart, D. E. (2002). Breast and cervical cancer screening in Hispanic women: A literature review using the health belief model. Women's Health Issues, 12(3):122-8. https://doi.org/10.1002/pon.750 DOI: https://doi.org/10.1016/S1049-3867(02)00132-9

Bauer, G. R., Hammond, R., Travers, R., Kaay, M., Hohenadel, K. M., & Boyce, M. (2009). I don’t think this is theoretical; this is our lives”: How erasure impacts health care for transgender people. J Assoc Nurses AIDS Care, 20(5):348-361 https://doi.org/10.1016/j.jana.2009.07.004 DOI: https://doi.org/10.1016/j.jana.2009.07.004

Bazzi, A. R., Whorms, D. S., King, D. S., & Potter, J. (2015). Adherence to mammography screening guidelines among transgender persons and sexual minority women. Am J Public Health, 105(11):2356–58. https://doi.org/10.2105/AJPH.2015.302851 DOI: https://doi.org/10.2105/AJPH.2015.302851

Boehmer, U., & Elk, R. (2015). Cancer and the LGBT community: Unique Perspectives from Risk to Survivorship. Springer. DOI: https://doi.org/10.1007/978-3-319-15057-4

Buchmueller, T., & Carpenter, C. S. (2010). Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007.

American Journal of Public Health, 100(3), 489-95. https://doi.org/10.2105/AJPH.2009.160804 DOI: https://doi.org/10.2105/AJPH.2009.160804

Centers for Disease Control and Prevention (CDC) a. Overview: BRFSS 2018. The Behavioral Risk Factor Surveillance System (BRFSS). 2019. Retrieved October 16 2022, from: https://www.cdc.gov/brfss/annual_data/2018/pdf/overview-2018-508.pdf

Centers for Disease Control and Prevention (CDC) b. Complex sampling weights and preparing 2018 BRFSS module data for analysis 2019. Retrieved December 09 2022, from: https://www.cdc.gov/brfss/annual_data/2018/pdf/Complex-Smple-Weights-Prep-Module-Data-Analysis-2018-508.pdf

Chen, S., & Qin, Y. (2023). On Ethics, Biomedical Education and Health Promotion: International and Chinese Perspectives. International Healthcare Review (online). https://doi.org/10.56226/46 DOI: https://doi.org/10.56226/46

Chen, Y. (2022). On the Social Epidemiology of the new pandemic world: Generating evidence on the long-term effects on society. International Healthcare Review (online), 1(1). https://doi.org/10.56226/ihr.v1i1.8 DOI: https://doi.org/10.56226/ihr.v1i1.8

Cochran, S. D., Mays, V. M., Bowen, D., Gage, S., Bybee, D., Roberts, S. J., ... & White, J. (2001). Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. American Journal of Public Health, 91(4), 591-597. https://doi.org/10.2105/ajph.91.4.591 DOI: https://doi.org/10.2105/AJPH.91.4.591

Cronin, K. A., Miglioretti, D. L., Krapcho M., Yu, B., Geller, B. M., Carney, P. A., Onega, T., Feuer, N., Breen, N., & Ballard-Barbash, R. (2009). Bias associated with self-report of prior screening mammography. Cancer Epidemiol Biomarkers Prev, 18(6):1699-1705. https://doi.org/10.1158/1055-9965.EPI-09-0020 DOI: https://doi.org/10.1158/1055-9965.EPI-09-0020

Deutsch, M. B., Radix, A., & Wesp, L. (2017). Breast cancer screening, management, and a review of case study literature in transgender populations. Seminars in Reproductive Medicine, 35(5): 434-41. Thieme Medical Publishers. DOI: https://doi.org/10.1055/s-0037-1606103

Gates, G. J. (2014). LGBT demographics: Comparisons among population-based surveys. Retrieved October 16 2022, from: https://escholarship.org/content/qt0kr784fx/qt0kr784fx.pdf

Haile, R. W., John, E. M., Levine, A. J., Cortessis, V. K., Unger, J. B., Gonzales, M., ... & Boffetta, P. (2012). A review of cancer in US Hispanic populations. Cancer Prevention Research, 5(2), 150-63. https://doi.org/10.1158/1940-6207.CAPR-11-0447 DOI: https://doi.org/10.1158/1940-6207.CAPR-11-0447

Kim, H. J., Jen, S., & Fredriksen-Goldsen, K. I. (2017). Race/ethnicity and health-related quality of life among LGBT older adults. The Gerontologist, 57(1), 30-9. https://doi.org/10.1093/geront/gnw172 DOI: https://doi.org/10.1093/geront/gnw172

Lee, H. Y., Ju, E., Vang, P. D., & Lundquist, M. (2010). Breast and cervical cancer screening disparity among Asian American women: does race/ethnicity matter?. Journal of Women's Health, 19(10), 1877-84. https://doi.org/10.1089/jwh.2009.1783 DOI: https://doi.org/10.1089/jwh.2009.1783

Uyeda, M. (2022). On a Global Agenda for Oncology Research: From Biomarker studies to post-genomic technologies. International Healthcare Review (online), 1(1). https://doi.org/10.56226/ihr.v1i1.9 DOI: https://doi.org/10.56226/ihr.v1i1.9

Malone, J., Snguon, S., Dean, L. T., Adams, M. A., & Poteat, T. (2019). Breast cancer screening and care among black sexual minority women: a scoping review of the literature from 1990 to 2017. Journal of Women's Health, 28(12):1650-60. https://doi.org/10.1089/jwh.2018.7127 DOI: https://doi.org/10.1089/jwh.2018.7127

McPhee, S. J., Nguyen, T. T., Shema, S. J., Nguyen, B., Somkin, C., Vo, P., & Pasick, R. (2002). Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Preventive Medicine, 35(5), 463-73. https://doi.org/10.1006/pmed.2002.1096 DOI: https://doi.org/10.1006/pmed.2002.1096

Meads, C., & Moore, D. (2013). Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies. BMC Public Health, 13(1), 1-11. https://doi.org/10.1186/1471-2458-13-1127 DOI: https://doi.org/10.1186/1471-2458-13-1127

Missmer, S. A., Eliassen, A. H., Barbieri, R. L., & Hankinson, S. E. (2004). Endogenous estrogen, androgen, and progesterone concentrations and breast cancer risk among postmenopausal women. Journal of the National Cancer Institute, 96(24), 1856-1865. https://doi.org/10.1093/jnci/djh336 DOI: https://doi.org/10.1093/jnci/djh336

Monachino, M. . (2022). On Healthcare Research for Disease Prevention: Critical Knowledge Gaps in European Public Health. International Healthcare Review (online), 1(1). https://doi.org/10.56226/ihr.v1i1.6 DOI: https://doi.org/10.56226/ihr.v1i1.6

Narayan, A., Lebron-Zapata, L., & Morris, E. (2017). Breast cancer screening in transgender patients: findings from the 2014 BRFSS survey. Breast Cancer Research and Treatment, 166(3), 875-79. https://doi.org/10.1007/s10549-017-4461-8 DOI: https://doi.org/10.1007/s10549-017-4461-8

National Cancer Institute. (2019). Surveillance, Epidemiology, and End Results Program website. Cancer Stat Facts: Female Breast Cancer. Retrieved December 22, 2022, from: https://seer.cancer.gov/statfacts/html/breast.html.external icon

National Center for Health Statistics. National Health Interview Surveys 2018. Public-use data file and documentation. 2019. Retrieved December 22, 2022, from: www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm

National Institute of Health. (2020). Breast cancer screening. 2020. Cancer Trends Progress Report. Retrieved December 12, 2022, from:


Ooi, S. L., Martinez, M. E., & Li, C. I. (2011). Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Research and Treatment, 127(3), 729-738. https://doi.org/10.1007/s10549-010-1191-6 DOI: https://doi.org/10.1007/s10549-010-1191-6

O’Keefe, E. B., Meltzer, J. P., & Bethea, T. N. (2015). Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000–2010. Frontiers in Public Health, 3, 51. https://doi.org/10.3389/fpubh.2015.00051 DOI: https://doi.org/10.3389/fpubh.2015.00051

Polek, C., & Hardie, T. (2019). Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members. Asia-Pacific Journal of Oncology Nursing, 7(1), 6-11. https://doi.org/10.4103/apjon.apjon_46_19 DOI: https://doi.org/10.4103/apjon.apjon_46_19

Rahman, M., Li, D. H., & Moskowitz, D. A. (2019). Comparing the healthcare utilization and engagement in a sample of transgender and cisgender bisexual+ persons. Archives of Sexual Behavior, 48(1), 255-60. https://doi.org/10.1007/s10508-018-1164-0 DOI: https://doi.org/10.1007/s10508-018-1164-0

Rauscher, G. H., Johnson, T. P., Cho, Y. I., & Walk, J. A. (2008). Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiology and Prevention Biomarkers, 17(4), 748-57. https://doi.org/10.1158/1055-9965.EPI-07-2629 DOI: https://doi.org/10.1158/1055-9965.EPI-07-2629

Stapleton, S. M., Oseni, T. O., Bababekov, Y. J., Hung, Y. C., & Chang, D. C. (2018). Race/ethnicity and age distribution of breast cancer diagnosis in the United States. JAMA Surgery, 153(6), 594-95. https://doi.org/10.1001/jamasurg.2018.0035 DOI: https://doi.org/10.1001/jamasurg.2018.0035

Shoemaker, M. L., & White, M. C. (2016). Breast and cervical cancer screening among Hispanic subgroups in the USA: Estimates from the National Health Interview Survey 2008, 2010, and 2013. Cancer Causes & Control, 27(3), 453-57. https://doi.org/10.1007/s10552-016-0718-5 DOI: https://doi.org/10.1007/s10552-016-0718-5

Solazzo, A. L., Gorman, B. K., & Denney, J. T. (2017). Cancer screening utilization among US women: How mammogram and pap test use varies among heterosexual, lesbian, and bisexual women. Population Research and Policy Review, 36(3), 357-77. https://doi.org/10.1007/s11113-017-9425-5 DOI: https://doi.org/10.1007/s11113-017-9425-5

United State Preventive Task Force (USPSTF). (2016). Final recommendation statement: Breast cancer screening. Retrieved December 22, 2022, from: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

Breast cancer screening image



How to Cite

Song, C., & Xie, H. (2023). On Disparities in Breast Cancer Screening: An Analysis of Behavioral Risk Factor Surveillance Survey Data related to Racial/ Ethnic characteristics. International Healthcare Review (online). https://doi.org/10.56226/53



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