A new study reveals that Pennsylvania’s insurance criteria for supplemental breast cancer screening may unintentionally disadvantage Black women. The law covers women with extremely dense breasts or heterogeneously dense breasts plus a high lifetime risk of breast cancer. But these criteria rely on models and assessments that underestimate risk in Black women.
Researchers analyzed over 68,000 mammograms and found that only 2.1% of Black women had extremely dense breasts, compared to 5.8% of White women. Just 0.7% of Black women had a lifetime breast cancer risk over 20%, versus 6.4% of White women. As a result, Black women were far less likely to qualify for supplemental screening—only 1.6% met the criteria, compared to 8.4% of White women.
The consequences are serious.
Among women who later developed cancer after a negative mammogram, none of the Black women would have been eligible for supplemental screening, while 29% of White women would have. “Our results suggest that expanding supplemental screening eligibility to all women with heterogeneously or extremely dense breasts would identify more false negatives,” the authors wrote.
However, broadening access would dramatically increase the number of MRIs, raising costs and straining resources. The study calls for better risk models that include race, BMI, and other factors to more accurately identify women at risk—especially Black women, who face higher rates of aggressive cancers and breast cancer mortality.
See: “Racial Differences in Screening Eligibility by Breast Density” (August 5, 2025)
