Abstract A155: State-level differences in breast cancer screening: The role of healthcare infrastructure and policy in mortality, morbidity, incidence, and prevalence

Abstract

Breast cancer is a major public health concern, and affects 1 in 8 women. However, different patient populations face the burdens of this disease unequally: African-American women are diagnosed at younger ages with more aggressive subtypes, and face mortality rates around 40% higher than White women. While structural inequities such as access to timely screening and treatment quality are a main reason for these gaps, current screening guidelines also rely on evidence from randomized controlled trials (RCTs) that underrepresent racially minoritized populations. Consequently, the trials underpinning national policies often fail to evaluate how screening interventions specifically affect women of color. This study investigates whether and how current clinical trial evidence informs breast cancer screening policies by examining the racial demographics of trials used to justify guidelines, and how racial and age disparities in outcomes are exacerbated by guideline changes and inconsistent state-level data collection practices. Strategies to analyze the data included constructing a subgroup database using Excel, integrating data primarily from the U.S. Cancer Statistics (USCS) Public Use Database, which compiles data from SEER and the CDC. Specific analysis into breast cancer incidence, morbidity, prevalence, and mortality trends from 2000 to 2023 across 51 states and regions focused on race, ethnicity, and age categories (<50 and 50+). The methodology also aimed to assess the variation in registry practices, such as electronic patient-reported outcome systems versus traditional paper-based/telephone methods, which impact the completeness and accuracy of reported demographic data. Our analysis confirmed that Black women face a disproportionate burden at younger ages; 23% are diagnosed before age 50 compared to 16% of White women. While national mortality has declined, large racial gaps persist: in states like Louisiana and Texas, Black women experienced mortality rates of ∼30 per 100,000 versus ∼21 per 100,000 for White women. Additionally, the 2009 and 2016 USPSTF guideline shifts, which delayed screening, correlated with a pronounced drop in early- stage detection among women aged 40–49, suggesting fewer early diagnoses in this group. Data quality also varied by state: electronic reporting yielded <5% missing race data, while states using paper/telephonic methods reported 15–25% "Unknown" entries. This study concludes that "one-size-fits-all" screening guidelines fail to capture high-risk subgroups and exacerbate health inequities. Data gaps and inconsistent registry practices reveal a weakness in the evidence base for screening policy, as fundamental trends for minority and multiracial women remain largely invisible. While the 2024 USPSTF updates increased equity by lowering the screening age to 40, further work is needed for more reliable, disaggregated data and recommendations that potentially incorporate race-specific risk factors to better tailor guidelines for populations with earlier disease onset. Grace Sun, Jaiden Burney, Julia Friedman, Rashmi Basu. State-level differences in breast cancer screening: The role of healthcare infrastructure and policy in mortality, morbidity, incidence, and prevalence [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A155.