# Regional Inequities in Mammography Access and Utilization in Latin America: Ethnic, Rural, and Structural Barriers Identified Through a Narrative Review

## TL;DR

Breast cancer screening through mammography is unevenly accessed in Latin America due to ethnic, rural, and health system barriers, requiring targeted solutions.

## Contribution

This paper identifies structural and social barriers to mammography access in Latin America through a narrative review of regional studies.

## Key findings

- Mammography coverage in Latin America ranges from 20% to 60%, with lower uptake among Indigenous and rural women.
- Structural barriers like urban-focused infrastructure and fragmented health systems hinder equitable screening access.
- Socioeconomic and educational disparities are strongly linked to reduced mammography utilization.

## Abstract

Background: Breast cancer remains a leading cause of morbidity and mortality among women in Latin America. Mammography is the most effective population-based tool for early detection; however, its impact is limited by persistent social, geographic, and structural inequities. Evidence from the region indicates that ethnicity, rural residence, and health system organization play a central role in shaping unequal access to screening services. Methods: We conducted a narrative review informed by a systematic search strategy, following PRISMA 2020 recommendations. Searches were performed in 17 international and regional databases in English and Spanish, covering publications from 2015 to 2025. Eligible studies included non-interventional quantitative designs reporting mammography access, utilization, or coverage among women residing in Latin American countries. Three reviewers independently screened records, extracted data, and classified determinants of inequality into sociodemographic, geographic, and health-system domains. Results: Of 532 records identified, 12 studies met the inclusion criteria, primarily from Mexico, Brazil, Peru, and Chile. Most analyses were based on nationally representative surveys. Mammography coverage ranged from approximately 20% to 60%, with consistently lower uptake among Indigenous women, rural populations, and women without health insurance. Reduced screening was associated with low educational attainment, socioeconomic disadvantages, rural residence, ethnic self-identification, and fragmented health system affiliation. Structural barriers, including concentration of diagnostic infrastructure in urban areas, reliance on opportunistic screening models, and limited capacity for systematic follow-up, were recurrent across countries. Conclusions: Inequities in mammography access and utilization in Latin America reflect deeply rooted social and structural determinants rather than a lack of screening technology alone. Reducing preventable breast cancer mortality requires strengthening organized, population-based screening programs, decentralizing diagnostic services, improving continuity of care, and implementing culturally appropriate strategies tailored to Indigenous, rural, and uninsured populations.