A national view of U.S. women ages 40–74 who had never had a mammogram or had not had one in more than two years.
2023 National Health Interview Survey (NHIS) · 2,173 valid respondents · ≈17.1 million survey-weighted U.S. women represented. Respondents named one “single most important reason.” The six headline groups below are researcher-created combinations of the 11 original survey responses.
These are analytical groupings of the original NHIS responses. They are descriptive, not causal explanations of why an individual mammogram did not happen.
Salience, postponement, or execution friction
Do not read this as purely “behavioral.” Work, caregiving, scheduling, transportation, fear, or other structural friction may sit underneath postponement.
Whether screening feels necessary or age-appropriate
This grouping combines distinct mechanisms: knowledge, perceived risk, symptom-based thinking, and perceived age eligibility.
A missing recommendation or order
This identifies the respondent’s reported reason. It does not tell us why a recommendation or order was absent.
Explicit financial or clinician-access barriers
The relatively small explicit share does not mean structural barriers affect only 7.4% of women; they can contribute to other reported reasons too.
Anticipated or experienced procedure burden
The survey combines pain, unpleasantness, and embarrassment, so these cannot be separated.
Reasons outside the predefined response categories
The public-use response does not reveal what these “other” reasons were.
These are descriptive findings from the survey—not causal claims about why screening fails.
Nearly four in ten reported either never thinking about mammography or putting it off.
About one in seven said their doctor did not order the mammogram or tell them they needed it.
Cost, insurance, or not having a doctor were named directly by about 7%. Structural barriers can still sit underneath “put it off,” “never thought about it,” and other responses.
The table preserves the 11 substantive NHIS categories rather than only the researcher-derived groups.
Sorted by weighted percentage. 95% confidence intervals account for the NHIS complex survey design.
| # | Reported reason | Weighted % | 95% CI | Unweighted n |
|---|---|---|---|---|
| 1 | No reason / never thought about it Attention & follow-through | 24.1% | 21.9–26.4% | 517 |
| 2 | Doctor didn’t order it / didn’t say I needed it Clinician recommendation | 14.4% | 12.6–16.3% | 306 |
| 3 | Put it off / didn’t get around to it Attention & follow-through | 13.3% | 11.7–15.0% | 299 |
| 4 | Other Other | 12.2% | 10.7–13.8% | 289 |
| 5 | Haven’t had any problems Perceived need / eligibility | 11.6% | 10.0–13.3% | 245 |
| 6 | Didn’t need it / didn’t know I needed this type of test Perceived need / eligibility | 8.1% | 6.8–9.6% | 173 |
| 7 | Too expensive / no insurance / cost Access & cost | 6.5% | 5.3–7.9% | 133 |
| 8 | Too painful, unpleasant, or embarrassing Test experience | 4.1% | 3.2–5.2% | 96 |
| 9 | I am too young Perceived need / eligibility | 3.9% | 2.9–5.1% | 69 |
| 10 | I am too old Perceived need / eligibility | 1.0% | 0.5–1.8% | 27 |
| 11 | Don’t have a doctor Access & cost | 0.9% | 0.5–1.5% | 19 |