Introduction 1 2 3 4 5 6 7 8 9 8 10 5 11 13 Materials and methods 8 Eligibility for NBCCEDP breast cancer screening services 7 14 15 Data sources CPS ASEC 16 17 NBCCEDP 8 Data analysis CPS ASEC 15 19 17 18 18 19 14 NBCCEDP In counting the total number of women who received at least one Program-funded mammogram in 2002 and 2003, women were classified into the race/ethnic categories used to estimate Program eligibility. About 2.4% of women who were screened did not claim any race or Hispanic origin. These women (12,653) were counted in the total number of women screened, but not in the specific race/ethnicity categories. NBCCEDP screening rates 3 Results 1 Table 1 Number and percentage of U.S. women aged 40–64 years who were eligible for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), 2002–2003 Race/ethnicity All women age 40–64 a Number (thousand) b Number (thousand) 90% CI c 90% CI Total 46,899 100 4,007 3,806–4,208 8.5 8.1–9.0 Non-Hispanic 42,504 90.6 2,991 2,817–3,166 7.0 6.6–7.4     White 34,403 73.4 1,972 1,835–2,109 5.7 5.3–6.1     Black 5,439 11.6 714 629–799 13.1 11.6–14.6     AI/AN 225 0.5 45 23–66 19.8 11.3–28.4     A/NH/OPI 1,977 4.2 221 173–268 11.2 8.9–13.4     Multiracial 460 1.0 41 20–61 8.9 4.6–13.2 Hispanic 4,395 9.4 1,016 909–1,122 23.1 20.9–25.3 AI/AN: American Indian and Alaska Native; A/NH/OPI: Asian and/or Native Hawaiian and other Pacific Islanders; Multiracial: two or more races a b c Source: Authors’ tabulations of data from the U.S. Census Bureau, Current Population Survey, 2003–2004 Annual Social and Economic Supplements 2 Table 2 Number and percentage of women eligible for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and U.S. women provided with mammography screening services, at least once, through NBCCEDP, between 2002 and 2003 Race/ethnicity Number of women screened a b % 90% CI Total 528,622 1.1 13.2 12.5–13.9 Non-Hispanic 349,655 0.8 11.7 11.0–12.4     White 221,433 0.6 11.2 10.4–12.0     Black 74,259 1.4 10.4 9.2–11.6     AI/AN 21,882 9.7 49.2 25.5–72.9     A/NH/OPI 30,687 1.6 13.9 10.9–16.9     Multiracial 1,394 0.3 3.4 1.7–5.2 Hispanic 166,314 3.8 16.4 14.7–18.1 Unknown Race/ethnicity 12,653 – – – AI/AN: American Indian and Alaska Native; A/NH/OPI: Asian and/or Native Hawaiian and other Pacific Islanders; Multiracial: two or more races NBCCEDP mammography eligible women include: uninsured women aged 40–64 with family incomes below 250% of federal poverty level a b Source: Authors’ tabulations of data from the U.S. Census Bureau, Current Population Survey, 2003–2004 Annual Social and Economic Supplements, and from NBCCEDP April 2005 data 2 2 3 Table 3 Number of women aged 40–64 and estimated number of women eligible for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), breast cancer screening, by state: 2-Year averages; 2002–2003 U.S. population Eligible women  Total a No. (thousands) 90% CI (thousands) b 90% CI (%) U.S. 46,899 200/250 3,594 3,403–3,785 7.7 7.27–8.06 Alabama 748 200 57 34–80 7.6 4.6–10.6 Alaska 103 250 9 5–12 8.5 5.5–11.6 Arizona 807 250 72 41–102 8.9 5.3–12.4 Arkansas 423 200 39 23–55 9.2 5.7–12.8 California 5,506 200 476 386–565 8.6 7.1–10.2 Colorado 714 250 55 35–75 7.7 5.0–10.3 Connecticut 585 200 23 12–34 4.0 2.0–5.9 Delaware 143 250 5 2–8 3.7 1.7–5.8 District of Columbia 92 250 6 3–9 6.6 3.5–9.7 Florida 2,805 200 262 206–318 9.3 7.4–11.2 Georgia 1,407 200 95 55–135 6.8 4.0–9.5 Hawaii 196 250 9 4–14 4.5 2.1–6.9 Idaho 213 200 16 9–23 7.2 4.1–10.4 Illinois 1,936 200 123 85–160 6.3 4.5–8.2 Indiana 1,011 200 60 36–83 5.9 3.6–8.2 Iowa 480 250 24 13–35 5.0 2.7–7.3 Kansas 429 250 24 13–35 5.6 3.1–8.0 Kentucky 669 250 80 54–106 12.0 8.4–15.6 Louisiana 712 250 108 75–142 15.2 10.9–19.5 Maine 219 250 14 8–19 6.2 3.9–8.6 Maryland 933 250 54 31–76 5.7 3.4–8.0 Massachusetts 1,061 250 40 21–60 3.8 2.0–5.6 Michigan 1,655 250 110 76–143 6.6 4.7–8.6 Minnesota 861 250 24 10–39 2.8 1.2–4.5 Mississippi 471 250 61 40–82 13.0 8.8–17.1 Missouri 894 200 51 28–73 5.7 3.3–8.2 Montana 159 200 15 9–21 9.2 5.7–12.8 Nebraska 276 225 15 7–22 5.3 2.8–7.9 Nevada 341 250 28 17–38 8.1 5.2–11.0 New Hampshire 225 250 11 6–16 4.9 2.7–7.0 New Jersey 1,458 250 96 66–126 6.6 4.6–8.6 New Mexico 295 250 46 31–62 15.6 10.7–20.5 New York 3,212 250 262 209–315 8.2 6.6–9.7 North Carolina 1,330 200 137 97–176 10.3 7.5–13.1 North Dakota 105 200 7 4–9 6.3 3.7–9.0 Ohio 1,968 200 115 79–151 5.8 4.1–7.6 Oklahoma 525 200 40 23–57 7.6 4.5–10.7 Oregon 615 250 45 27–62 7.2 4.5–10.0 Pennsylvania 2,070 250 111 77–145 5.4 3.8–7.0 Rhode Island 181 250 9 5–13 4.9 2.9–7.0 South Carolina 671 200 48 28–68 7.2 4.3–10.0 South Dakota 116 200 8 5–11 6.7 4.1–9.4 Tennessee 1,025 250 70 40–100 6.8 4.0–9.7 Texas 3,205 200 396 318–474 12.4 10.1–14.7 Utah 302 250 19 10–29 6.4 3.3–9.4 Vermont 115 250 5 2–7 4.1 2.1–6.1 Virginia 1,245 200 62 33–91 5.0 2.7–7.2 Washington 1,073 200 70 41–99 6.5 3.9–9.1 West Virginia 311 200 32 22–42 10.2 7.1–13.4 Wisconsin 920 250 45 26–65 4.9 2.8–7.0 Wyoming 85 250 9 6–12 10.5 7.1–13.9 a b Source: Authors’ tabulations of data from the U.S. Census Bureau, Current Population Survey, 2003–2004. Annual Social and Economic Supplements. 1 Fig. 1 Note  Discussion We found that a large number of women—4 million women or 8.5% of all U.S. women aged 40 to 64—were uninsured during 2002–2003 and had incomes below 250% of the federal poverty level, meeting Program eligibility requirements. Of these, only about 13.2% received mammograms funded through the Program. Although many of the estimates for groups of women classified by race/ethnicity were imprecise, as indicated by wide CI, there was clearly wide variation in numbers and percentages of women eligible for the Program and in the percentages of eligible women who were screened. The percentage of eligible women screened was highest among American Indians and Alaska Natives. Although the estimates of eligible women in each state were also imprecise, the findings clearly showed wide variability. The percentage of eligible women screened in each state ranged from approximately 2% to approximately 79%. 8 The largest numbers of women eligible for the Program were non-Hispanic White women. In contrast, the largest percentages of women eligible for the Program were from minority groups, except for women of Two or More Races. Hispanic and non-Hispanic American Indian/Alaska Native groups had the highest percentages of eligible women. We were limited in our ability to assess the extent to which the Program met the mammography screening needs of women by race/ethnicity because about 12,000 women screened in the Program were of unknown race/ethnicity. If we had been able to correctly allocate these women to their appropriate race/ethnic groups, the percentages of women screened would have differed from those shown, potentially by an important margin. However, the findings indicate that the Program was most successful in meeting the needs of American Indian/Alaska Native women, approximately 49% of whom were screened. A possible reason for this success may be that these populations are the focus of health services through which the Program operates. In 1993, Congress amended the Breast and Cervical Mortality Prevention Act, Public Law 108-183, to authorize funding for American Indian/Alaska Native organizations and provided the opportunity to direct resources to these populations, specifically four grantees in Alaska and another nine geographically distributed across the contiguous United States. 18 18 20 3 21 Second, the Program needs to improve collaboration and coordination with other providers that serve a similar client population. The Program already coordinates substantially with private and nonprofit organizations, businesses, and other groups involved in breast cancer screening, but that coordination needs to be increased to recruit the women who are not currently being served. For example, in addition to providing screening services, the Program provides diagnostic services for eligible women screened by organizations outside of the Program. Alternative sources of diagnostic services may need to be pursued to free resources for increased screening of eligible women. Although greater efficiency and improved coordination with other screening providers could better meet the needs of underserved women, they are unlikely to be enough. Given that about 2.3 million low-income uninsured women did not obtain recommended breast cancer screening services in 2003 and that the Program provided those services to about 500,000 women; increased efficiency and coordination alone will be insufficient to meet the needs of the eligible population. Healthy People 2010 12 5 5 Healthy People 2010