Beyond The Numbers: New Model Helps Radiologists Target True Mammography Screening Gaps

A Radiology: Imaging Cancer study helps radiologists and health systems distinguish true underperformance from structural barriers by comparing each county’s screening rate with an expected rate based on sociodemographic factors, including insurance coverage, education, language proficiency and rurality.

Leveraging data from 3,121 counties, this expected-rate benchmarking model used sociodemographic factors to model expected screening rates, better characterizing how systems perform relative to expectations. Lead author Randy C. Miles, MD, MPH, breast imaging section chief at the University of Chicago, emphasized that raw percentages alone can be misleading.

“The key takeaway is that screening engagement is strongly shaped by sociodemographic context, so raw numbers alone do not tell the full story when accessing system performance and population health initiatives,” said Dr. Miles, whose work focuses on early detection, population health and access in community and safety-net settings.

By estimating a county’s screening rate based on its population profile, the result is a clearer benchmark for radiology practices, health systems and policymakers to better evaluate barriers to care and identify appropriate interventions.

Dr. Miles and colleagues found that higher rates of uninsured residents and limited English proficiency were associated with lower screening engagement, while higher education levels and insurance coverage were associated with better participation.

The model didn’t just flag gaps; it also identified counties that exceeded expected screening performance after sociodemographic factors were considered. Those high-performing regions may offer practical lessons for counties with similar profiles that are not performing as well, according to Dr. Miles.

“The fact that some counties exceed expectations shows that structural barriers can be overcome with tailored strategies,” he said. “These high-performing areas point to practical, targeted approaches that can be implemented to close gaps that contribute to disparate care.”

Dr. Miles pointed to strategies such as stronger patient navigation, mobile screening services, better primary care integration and deeper community partnerships as examples of interventions that may help improve screening rates in underserved areas.

For Gary J. Whitman, MD, professor of breast imaging and breast radiation oncology at The University of Texas MD Anderson Cancer Center in Houston, the value of the research lies in how it shifts radiologists’ thinking upstream.

“Oftentimes, we don’t know the steps beforehand—what led the patient to us, or perhaps more importantly, what prevented a patient from coming to us,” Dr. Whitman said. “That perspective is critical in screening settings, where success depends not only on image interpretation but on whether patients can access care in the first place.”