Key takeaways:

• Communities redlined in the mid-1900s currently have significantly lower breast cancer screening rates than higher-graded areas.
• Interventions should be directed to these redlined neighborhoods.

Historic redlining continues to have a significant association with adverse health outcomes — including lower breast screening rates — despite being banned nearly 60 years ago.

Women in redlined communities, segregated in the mid-1900s because of racial composition, had 6% lower odds of getting mammograms than those who lived in neighborhoods the government graded the best.

Data derived from Rahman MA, et al. JAMA Netw Open. 2026;doi:10.1001/jamanetworkopen.2026.30685.

“We were struck by how persistent the effect remained after accounting for other contemporary social vulnerability, and then neighborhood conditions,” Dinesh Pal Mudaranthakam, PhD, MBA, MS, assistant professor of biostatistics and data science at The University of Kansas Medical Center, told Healio.

Historic redlining

According to data previously reported by Healio, the federal government created the Home Owners’ Loan Corporation (HOLC) in the early 1930s to assist with home buying following the Great Depression. The HOLC drew maps around neighborhoods to identify who to give loans to.

The HOLC appraised communities based on their racial, economic, educational and social makeup. They graded communities from “A” to “D,” with “A” being the best and “D” being the worst. D-graded neighborhoods usually had the highest number of nonwhite residents and were outlined in red on maps. Most lenders did not grant loans to individuals who lived in “D” neighborhoods, or those who wanted to buy homes in those communities.

The 1968 Fair Housing Act outlawed redlining. However, many studies have shown the impact of redlining has continued, including breast cancer outcomes.

Healio previously reported women with breast cancer who lived in redlined communities had significantly worse 5-year OS than those who lived in “A” neighborhoods.

“One in every eight women get diagnosed with breast cancer in their lifetime, and it’s higher with African American women,” Mudaranthakam said.

Mudaranthakam and colleagues sought “actionable evidence” to help treat their Black patients, and hypothesized historic redlining could have an impact on mammogram rates.

They used 2016 to 2024 data from The University of Kansas Cancer Center catchment area, which included 123 counties (105 in Kansas; 18 in Missouri), to investigate.

Their study included 1,152 census tracts.

Breast cancer screening served as the primary endpoint.

Lack of investment

More than half (52.3%) of studied tracts had a “D” designation, followed by “C” (36.7%), “B” (8.6%) and “A” (2.3%).

All census tracts combined had a median screening rate of 76.3%, but they significantly differed based on HOLC grade (P < .001). “A” tracts had the highest rate (79.6%), followed by “B” (78.2%), “C” (77.1%) and “D” (75.2%).

Compared with “A” tracts, researchers observed significantly lower screening odds among “C” (OR = 0.94; 95% CI, 0.9-0.99) and “D” (OR = 0.94; 95% CI, 0.89-0.99) tracts.

Tracts in the highest social vulnerability quintile had significantly higher screening likelihood than the lowest social vulnerability quintile (OR = 1.08; 95% CI, 1.01-1.14).

Conversely, lack of high school diploma had a significant association with lower screening odds (OR = 0.94; 95% CI, 0.92-0.96), as did higher prevalence of mobile homes (OR = 0.98; 95% CI, 0.97-1).

“These geographical clusters existed where we saw lower screening rates despite the screening facilities being near the redlined area,” Mudaranthakam said “This suggests that access alone does not fully explain the disparity. Broader social and structural factors continue to affect screening uptake.”

Poverty (44.5%) and lower educational attainment (25.5%) mediated portions of the screening difference between “A” and “D” tracts.

A temporal analysis showed breast cancer screening rates increased from 2016 to 2019, stabilized from 2020 to 2023, but declined in 2024.

Most tracts (84.4%) during the study period fell below the Healthy People 2030 screening goal rate of 80.3%.

“We were surprised at how many communities remained below the national screening targets, highlighting the need for more place-based outreach and intervention strategies,” Mudaranthakam said.

Researchers acknowledged study limitations, including use of census-tract estimates.

The University of Kansas has already started using these data to help improve screening rates, including using their mobile mammogram bus to target these redlined areas.

“We want to house that bus in these redlined areas more often,” Mudaranthakam said.

Mudaranthakam and colleagues also want to evaluate where patients predominantly go for primary care, and see if programs can be implemented with those clinics’ assistance.

A study involving lung cancer screening could provide key data, too.

“Missouri is known to have the least tobacco taxes,” Mudaranthakam said. “We want to study lung cancer screening in a similar fashion.”

The impact of redlining will continue, though, until greater investments are made in these communities.

“Talking to policymakers, we realized that redlined areas continue to be treated as redlined areas even today,” Mudaranthakam said. “Over the years, the investment in these redlined areas continued [to be substandard]. We have got to make sure we are screening more in these redlining areas, but we have to push the envelope to get more investment. Over the last 100 years, we have continued to ignore these redlined areas. We have to change that.”

For more information:

Dinesh Pal Mudaranthakam, PhD, MBA, MS, assistant professor of biostatistics and data science at The University of Kansas Medical Center and co-director of the biostatistics and informatics shared resource at The University of Kansas Cancer Center, can be reached at dmudaranthakam@kumc.edu.