Why women delay mammograms – and how 2 radiologists hope to help

It's October, and that means Breast Cancer Awareness Month. Breast cancer deaths have fallen by 44% since 1989, yet one in five United States women still goes unscreened and over 1/3 delay screening.

Breast cancer screening poses several obstacles. The first is logistical. For most insured women, screening mammograms are covered at no out-of-pocket cost, and the CDC funds a program that provides free or low-cost screening to eligible women. If the cost hurdle is cleared, issues of geography, work, caregiving and scheduling surface.

"When you're busy working, picking up your children, with 25 things on the to-do list, when you feel great, screening mammogram is No. 26," says Dr. Ryan Polselli, a Tampa-based radiologist specializing in breast cancer imaging.

Mammography can also be painful – the second obstacle. I can attest that, at a minimum, it's highly uncomfortable having one's breast tissue flattened between cold, hard plates. Last year, I had a particularly rough technician and experienced pain for three days after. Nervousness can intensify pain perception.

The third obstacle is psychological. Anticipatory anxiety is a leading reason women cite for screening delay. Many fear a diagnosis, so not knowing can feel better than knowing. Others may imagine the worst while waiting for results, which can take up to 10 days. Modesty or cultural beliefs can make exposing one's breasts to a stranger uncomfortable. And some women worry about false positive results – and for good reason: roughly one in 10 mammograms leads to a callback for additional testing, although most of these women do not have cancer.

What would happen if health care were deliberately designed around these logistical, psychological and cognitive barriers? Polselli has made that question central to his work. His mobile breast cancer screening service, Mammolink, was conceived "through the eyes of the patient." Mammolink is one of 133 mobile mammography clinics nationwide, part of a growing movement to bring health care directly to patients. "We went through the list one by one to take every single objection off the table," Polselli said.Screening on wheels addresses the most obvious logistical barrier. Polselli brings screening to employer groups and schools to accommodate job responsibilities, even providing substitute teachers to minimize classroom disruption. He simplifies sign-up and clarifies insurance coverage, billing and financial assistance up front. Annual screenings are scheduled at the same locations and around the same dates each year.

"It's just another thing they don't have to think about," he explains.

Psychological barriers to screening are trickier. Same-day results reduce worry time. Workplace screening can create social momentum.

"You have your coworkers and friends; you all get screened together. It's kind of like ‘I voted,' right?" Polselli observes.

But even mammography at your doorstep cannot eliminate every reason for screening avoidance. Pain, embarrassment and anxiety about the procedure remain potent barriers. Is there a better way?

Dr. Mary Salvatore, Chair of Radiology at Jacobi Medical Center in New York, thinks there may be. "I have myself delayed screening because I don't want to risk the pain and the discomfort of it," she said. Salvatore is currently investigating low-dose non-contrast CT as an alternative to mammography for breast cancer screening.

Her idea grew out of her work reading CTs for lung-cancer screening, where she noticed how clearly breast tissue could be visualized. "Why would you hold on to something that was invented in the ‘60s that has all these challenges for women?"

She sees several advantages for CT. Scans are 30 seconds, involve no compression and women remain clothed. When you factor in supplemental imaging, cost and radiation exposure are comparable to mammography, she says, but CT can image the entire breast and underarm lymph-node region. CT can quantify subtle differences in breast tissue density. Salvatore is studying whether CT can detect cancers more accurately while reducing callbacks and false positives.

For now, mammography remains the recommended screening modality. But availability doesn't guarantee participation. Patients do not encounter the health system as abstract rational actors. They bring their own competing obligations, beliefs and emotions. Health care should be designed with that reality in mind.

Kelly Rogers Victor, Ph.D., MPH, MPP is a writer and consultant on nutrition, health policy and public health. Her columns appear regularly in The Detroit News. Reach her at Kelly@upstreamhealthconsulting.com.

This article originally appeared on The Detroit News: Why women delay mammograms – and how 2 radiologists hope to help

Reporting by Kelly Rogers Victor, The Detroit News / The Detroit News

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This story was originally published October 25, 2026 at 4:00 AM.