Eligibility for and reach of the National Breast and Cervical Cancer Early Detection Program, 2018-2021.

Purpose: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to timely breast and cervical cancer screening and diagnostic services to women who have low incomes and are uninsured or underinsured. Documenting the number of women eligible and the proportion of eligible women who receive NBCCEDP-funded services is important for identifying opportunities to increase screening and diagnostic services among those who would not otherwise have access.

Methods: Using the Census Bureau's Small Area Health Insurance Estimates data, we estimated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these estimates along with the number of women served by the NBCCEDP to calculate the percent of women served by race/ethnicity and state. We calculated the percent of eligible women who are up to date with screening using the 2019 National Health Interview Survey.

Results: The NBCCEDP served 15.0% of women ages 40-64 eligible for breast cancer services in 2018-2019 and 5.6% of women ages 21-64 eligible for cervical cancer services in 2018-2020. The NBCCEDP served 13.5% of women ages 40-64 eligible for breast cancer services in 2020-2021 and 5.9% of women ages 21-64 eligible for cervical cancer services in 2019-2021. The percent of women ages 40-64 who received breast cancer services declined by 1.5 percentage points between 2018-2019 and 2020-2021. The percent of women ages 21-64 who received cervical cancer services increased by 0.3 percentage points between 2018-2020 and 2019-2021. The percent of eligible women served varied among states. The state interquartile ranges of the percent of women served were 12.3-27.7% for breast cancer services in 2018-2019 and 3.9-14.7% for cervical cancer services in 2018-2020. Among women eligible for the NBCCEDP, 61.4% are not up to date with breast cancer screening and 40.6% are not up to date with cervical cancer screening.

Conclusion: There is wide variation between states in the share of eligible women served for breast and cervical cancer screening services. We found that both the number and the percentage of eligible women who received NBCCEDP breast cancer services declined during a period that overlapped with the COVID-19 pandemic. A large proportion of eligible women did not receive breast or cervical cancer screening.