A new report from the Milken Institute identifies large disparities in breast cancer screening access across U.S. counties, projecting that roughly 9,600 breast cancer cases could be detected earlier each year if underserved regions performed at the level of their better-resourced counterparts.

The November 2025 report analyzes the geographic distribution of certified mammography machines nationwide and links local capacity to cancer detection rates. Researchers found that nearly 900 U.S. counties—many of them rural—have no mammography machines at all. Counties with low or no capacity tended to have smaller populations, higher poverty rates, and lower rates of insurance coverage. They also had higher percentages of racial and ethnic minority residents, limited-English-speaking households, and women who had not received a mammogram in the previous year.

While some counties with low capacity still achieve relatively strong detection rates, the report identifies a core group of 97 counties where both screening infrastructure and detection rates are low. These areas, concentrated in the Southwest and parts of the central U.S., could see the largest gains from additional mammography deployment.
The study estimates that more than 4,000 of the additional cases potentially detectable through improved access would be diagnosed as ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer that is often treatable when caught early. Researchers used facility data from the FDA’s Mammography Program Reporting and Information System, combined with cancer incidence and demographic data from federal and state health sources.

A set of 74 counties, including Broward County, Florida, and Adams County, Colorado, stood out as high-return areas for new screening equipment. These locations were flagged for their potential to significantly increase both overall and early-stage cancer detection if machine access were expanded.

However, the report cautions that equipment alone will not solve the problem. Screening rates are also shaped by affordability, transportation, work schedules, cultural and language barriers, and a lack of engagement with the health-care system. Even in areas with high capacity, detection rates vary—suggesting that multiple factors influence outcomes beyond machine availability.

“Mammography is an important first step in improving breast cancer outcomes; you cannot treat what you cannot detect,” the report notes. It also points to emerging technologies—such as AI-supported diagnostics and 3D mammography—as tools that may improve detection accuracy but require careful deployment to reach the populations most in need.

The authors call for targeted investment in both infrastructure and broader support services to close the gap in women’s preventive health access.

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