Bridging the Gap in Breast Cancer Screening Disparities for Underserved East Tennessee Women Through a Mobile Mammography Unit Program

Women in rural East Tennessee Appalachia face persistent barriers to timely breast cancer screening including limited imaging facilities, unreliable transportation, and underinsurance. Many communities in this region do not have local access to breast imaging. Six counties in this Mobile Mammogram Unit (MMU) service area, including Fentress, Grainger, Hancock, Morgan, Scott, and Union, have no stationary breast imaging equipment, requiring thirty to sixty minutes of travel for a mammogram. The University of Tennessee Medical Center (UTMC) MMU provides 3D screening six days a week across nineteen counties, bringing services directly to where women live, work, shop, and worship. The program's longstanding reported success highlights the importance of mobile healthcare in reducing screening disparities.

The program partners with low-income clinics, primary care practices, churches, and minority resource agencies to reach Rural Appalachian, Urban Black, and Hispanic/Latina women regardless of insurance status. Annual return visits build trust and allow women to maintain regular screening. Screenings occur regardless of ability to pay, supported through grants and community collaborations that help sustain this long-standing program. Bilingual materials, community outreach, and dedicated breast navigators support completion of diagnostic follow-up and reduce structural barriers. A prospectively maintained database allows continuous evaluation and improvement of services.

A retrospective analysis was conducted using a prospectively maintained database of MMU screenings from 2008 to 2023, totaling 48,385 mammograms and 20,254 unique women. Variables included demographics, insurance and payment status, screening frequency, BI-RADS assessments, recall recommendations, and diagnostic outcomes. Analyses included frequency distributions and cross-tabulation tables.

Among the 20,254 women screened, n=2,024 (10%) were uninsured, and n=1,822 (9%) identified as minorities. The MMU completed an average of 14 mammograms per day with an 11% diagnostic recall rate. Diagnostic completion reached 90% through navigator assistance. Early-stage breast cancer, defined as stage 0 or 1, was diagnosed in n=190 (80%) of detected cancer, and the program met the national benchmark for a breast cancer detection rate equaling n=238/48,385 (0.5%).

MMU screening services can be implemented in rural, urban, vulnerable, and at-risk populations through grants and sustained community partnerships. Returning the MMU annually strengthens trust, improves navigation and diagnostic compliance, and increases access to timely screening. This model reduces screening disparities, and lives are saved with early detection.