Mammography Matters: A Quality Improvement Study of Breast Cancer Screening Gaps Among Insured Women

Background and objectiveBreast cancer screening reduces breast cancer mortality, yet screening gaps persist, particularly among underserved populations.These gaps may occur at different points in the screening process, including patient refusal, failure to complete an ordered mammogram, or absence of a documented screening order.This quality improvement project examined breast cancer screening gaps among insured women aged 50-74 years receiving care at an urban federally qualified health center (FQHC).The objective of this study was to characterize patient-reported mammography hesitancy/concerns and reasons for noncompletion among insured women aged 50-74 years at an urban FQHC and determine whether these reported barriers differed by age group or insurance type. MethodsThis quality improvement project used retrospective electronic medical record review and prospective telephone outreach to characterize breast cancer screening gaps and patient-reported barriers to mammography.A total of 988 women aged 50-74 years without documented screening within the previous two years were identified at an urban FQHC.After application of exclusion criteria, 851 insured women remained for screening-status classification.Patients were classified according to screening status, including mammography refusal, noncompletion of an ordered mammogram, and true gaps in care.Barrier analyses included 120 women in the mammography hesitancy/concern analytic sample and 174 women in the noncompletion analytic sample. ResultsBarrier analyses included 120 women in the mammography hesitancy/concern analytic sample and 174 women in the noncompletion analytic sample.No statistically significant associations were detected between age group and reported mammography hesitancy/concerns (χ²(6) = 8.57, exact p = 0.202) or reasons for noncompletion (χ²(6) = 7.15, exact p = 0.3101).Similarly, no statistically significant associations were detected between insurance type and reported mammography hesitancy/concerns (χ²(6) = 6.21, exact p = 0.408) or reasons for noncompletion (χ²(6) = 4.86, exact p = 0.5698). ConclusionsAmong insured women aged 50-74 receiving care at an urban FQHC, no statistically significant associations were detected between age group or insurance type and patient-reported mammography hesitancy/concerns or reasons for noncompletion.These findings should be interpreted cautiously given the subgroup sizes and sparse cell counts.Screening gaps within this population may reflect multifactorial barriers that are not readily explained by age or insurance type alone, highlighting the importance of patient-centered approaches addressing structural barriers, communication gaps, and competing life demands.