"It's Not Just Cost": Barriers to Mammography Screening Access Among Low-income Women in the United States-A Scoping Review.

Abstract

Despite the recognized importance of early detection, disparities in mammography access persist among low-income women in the United States. While financial barriers are often emphasized, less is known about how multiple barriers interact to shape access to screening. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to synthesize evidence on barriers to mammography access among low-income women in the United States. A systematic search of PubMed, CINAHL, and Google Scholar identified peer-reviewed studies published between 2010 and 2025, of which 47 met inclusion criteria. Extracted barriers were categorized into five domains: financial, structural, informational, cultural/social, and systemic. Barriers were multidimensional and frequently co-occurred across domains. Structural barriers, including transportation challenges and limited clinic availability, were the most reported, followed by financial and informational constraints. Cultural factors such as fear, stigma, and mistrust, along with systemic issues including provider bias and fragmented care coordination, further constrained access. Across studies, barriers rarely operated in isolation but instead reinforced one another, producing layered disadvantage that limited both screening uptake and follow-up care. These findings highlight the need for integrated, multi-level interventions that address structural, informational, and systemic barriers simultaneously. Expanding insurance coverage alone is insufficient; improving access will require strengthening patient navigation, enhancing care coordination, and embedding culturally responsive approaches within health systems.