Breaking Barriers: An Interview with Dr. Priscilla Slanetz on Breast Cancer Screenings

Breast cancer is one of the most common cancers among women in the US, yet disparities in diagnosis, treatment, and outcomes remain a critical public health issue. Black women in particular face higher mortality rates despite lower incidence compared to White women. According to the American Cancer Society, Black women have a 38% higher mortality rate from breast cancer even as they have a 5% lower breast cancer rate. This is a disparity that has remained stagnant for the past decade and is even greater for Black women under 50. Dr. Priscilla J. Slanetz, Professor of Radiology and former Section Chief of Breast Imaging at Boston Medical Center (BMC), is working to change that. 

In an interview, Dr. Slanetz described how her path to breast imaging was shaped by her background and passion for public health. Her interest in radiology stemmed from a desire to work across multiple medical fields and apply her advocacy skills to a pressing major health issue. “Breast cancer is a real public health problem,” she explains, “With a public health perspective, you can really make a difference through advocacy and community outreach.”

Unlike many radiologists, Dr. Slanetz interacts directly with patients, guiding them through the diagnostic process and ensuring they understand their imaging results. This patient-centered approach has been deeply fulfilling for her and has allowed her to build trust within the community.

One of the challenges in breast cancer care is ensuring equitable access to early detection and treatment. When Dr. Slanetz arrived at BMC eight years ago, the hospital’s screening guidelines were based on recommendations from the U.S. Preventive Services Task Force, an independent, volunteer group of national experts in prevention and evidence-based medicine, which advised mammograms every other year starting at age 50. However, research shows that Black women tend to develop breast cancer at younger ages and often face worse outcomes.

Because of this, Dr. Slanetz conducted a study at BMC, analyzing patient outcomes based on screening history from the past decade. The results were clear: women who had not undergone a mammogram within 18 months prior to a breast cancer diagnosis were more likely to be diagnosed with later-stage cancer and have poorer survival rates. Armed with this data, she worked with breast surgeons and primary care providers at BMC to change the hospital’s screening guidelines, ensuring that all women have access to annual mammograms starting at age 40. 

However, starting mammograms at 40 may not be early enough for Black women. This is because breast cancer screening guidelines have been based on studies that largely excluded Black women. Because of this, the current screening guidelines may not be accurate for Black women. “We know that the peak incidence of breast cancer in Black women occurs about a decade earlier than in White women,” Dr. Slanetz explains, “That raises the question: should Black women be screened even earlier than 40? The problem is, we don’t have enough data to answer that yet.” 

Dr. Slanetz emphasizes that inclusive research is critical for developing guidelines that reflect the needs of diverse populations. BMC’s strong ties to the community have helped build trust, making it easier to conduct research that can directly benefit Black women and other historically underserved groups. 

More recently, Dr. Slanetz led a study examining barriers for another underserved group: people with low incomes. She focused on how high-deductible health plans impact patients’ willingness to seek screening and follow-up care. “We found that up to 20% of our patients would forgo a mammogram if they had to pay anything out of pocket,” she explained. This financial barrier contributed to delays in diagnosis and treatment, exacerbating disparities in breast cancer outcomes.

Dr. Slanetz used these findings to advocate for legislative change at the Massachusetts State House. In January 2026, Massachusetts will implement a new law eliminating out-of-pocket costs for mammograms and diagnostic breast examinations for breast cancer. “This is a huge step forward,” she says, “Now, women won’t have to choose between financial hardship and their health.”

Another focus of Dr. Slantz is dense breast tissue, a common condition where there is more glandular tissue than fatty tissue in the breasts. This condition can complicate mammogram interpretations and disproportionately affect certain groups. Overall, around 50% of women in the US have dense breasts, but the degree of density can vary. There are two primary categories: heterogeneously dense and extremely dense. While both can complicate mammogram interpretations, it is the extremely dense tissue that can be worrisome, Dr. Slanetz explains.

Mammograms rely on X-rays to detect abnormalities in the breast, but dense tissue can make it more difficult to spot cancers. This is because both dense tissue and cancerous masses appear white on a mammogram. As the density of the breast tissue increases, the ability to detect cancer decreases. Dr. Slanetz explains that “in women with extremely dense tissue, the sensitivity of a mammogram drops from 90-95% to around 60-70%.” While mammograms are still effective for most women with dense tissue, the risk of missing cancers is higher in the most extreme cases. 

This can translate to an unequal burden for Black women in particular. According to a study about racial differences in breast density by Anne Marie McCarthy, PhD., Black women had “40% to 51% higher odds of high density than White women.” This disproportionate rate of breast density may translate into more difficulty in discovering an early-stage cancer in some Black women.

One helpful technology to “see through” the dense tissue is digital breast tomosynthesis (DBT), or 3D mammography. DBT is a promising advancement in mammography because unlike traditional 2D mammograms, it takes multiple low-dose X-ray images from different angles and reconstructs them into thin slices. One of the biggest benefits of DBT is its ability to differentiate overlapping tissue, which can create false positives in 2D mammograms. This means fewer unnecessary callbacks for additional images. However, DBT is not always available, and Dr. Slanetz emphasizes that the most important thing is to get a mammogram—digital or otherwise—rather than not getting screened at all. 

Dr. Slanetz stresses that “DBT can be helpful for all women, but particularly for women with dense breasts. It helps reduce the false positive rate and allows us to detect more cancers.” While dense breast tissue is an independent risk factor for breast cancer, which the American Cancer Society hypothesizes is due to there simply being more cells in the breast tissue, it’s just one piece of the puzzle. A woman’s overall risk is determined by a variety of factors, so regardless of their breast density, it’s crucial for women to get a comprehensive risk assessment starting in their mid-20s. Dr. Slanetz explains, “A detailed risk assessment takes into account not just breast density but also other factors like family history and genetic testing.”

“Risk assessments are so important,” Dr. Slantez says, “It’s about understanding your individual risk and whether additional screening, like an MRI, is necessary.” For women with high or elevated risk, MRI screenings may be recommended in addition to mammograms, as they are much more sensitive and can detect cancers that may be missed by traditional mammography.

However, despite advancements in technology, many women experience anxiety about mammogram screenings, whether due to fear of pain, concerns about radiation exposure, or the emotional weight of a potential cancer diagnosis. 

One common concern is the discomfort that comes with the compression of the breast during a mammogram. Dr. Slanetz explains that the compression is necessary for two reasons: “One, we need to immobilize the breast so there’s no motion, because if there’s motion, we might miss cancers. But the main reason the breast is squeezed is to make the tissue as thin as possible so that the radiation dose is very, very low.” Dr. Slanetz emphasizes that mammograms do not cause cancer because the radiation dose is too low. While the compression may be uncomfortable, it lasts only seconds and should not be painful. If a mammogram is painful, it may indicate improper positioning, and women should not hesitate to communicate their discomfort to the technologist. 

Another major fear is the possibility of receiving a cancer diagnosis. However, Dr. Slanetz explains that early detection is key to successful treatment; “If you have breast cancer, wouldn’t we want to find it before you can feel it?” Catching cancer in its early stages often means less invasive treatments, lower chances of requiring chemotherapy or radiation, and a significantly higher likelihood of a full recovery. Mammograms are the only screening tool proven to reduce the risk of dying from breast cancer. A study by Stephen Duffy, Director of the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis at the University of London, found mammograms result in a 30-45% reduction in mortality.

The impact of mammogram hesitancy is especially concerning within the Black community, where breast cancer tends to occur at younger ages and in more aggressive forms. Dr. Slanetz points out that not only are Black women often diagnosed a decade earlier than their White counterparts, they may also develop more biologically aggressive tumors. Despite this, there remains a significant reluctance to undergo regular screenings, often due to factors such as misinformation, work constraints, and historical distrust in the medical system. To improve access, institutions like Boston Medical Center have implemented measures such as free transportation and Saturday appointments, which have been particularly popular. She also highlights the importance of community support; “We see sisters coming together, mothers and daughters coming together. Having your support person with you is totally fine and is encouraged.”

Despite these efforts, Dr. Slanetz shares, “We just don’t see some Black women regularly, and some of them don’t come to appointments—we still don’t fully understand why we have a 15% no-show rate. There are other barriers beyond cost, and we need to address them.”

Dr. Slanetz urges women not to let misconceptions or a fear of a diagnosis prevent them from getting screened; “The most important thing is people need to come in. They cannot be scared that they’re going to have cancer. The majority of women will not have cancer, but if you’re going to be that one in eight, my advice is to find it early.” Long periods of time without regular breast screenings can let cancer grow unchecked and ultimately lead to worse health outcomes. 

She also encourages Black women who have experienced breast cancer to share their stories; “Those are usually the best people to lead the charge.” Raising awareness and creating supportive environments can make a significant impact in reducing breast cancer disparities and ensuring early detection for all women.

By addressing common concerns and emphasizing the benefits of mammograms, Dr. Slanetz hopes to encourage more women—especially those in high-risk communities—to take charge of their breast health. Get a risk assessment, learn about risk factors, and make a mammogram appointment or simply walk in if your healthcare center offers it. You can bring a support person if you need one. Dr. Slanetz has one straightforward request: “Please come in,” she urges, “We really just want to help people and make sure no one suffers unnecessarily.”

To schedule an appointment for a mammogram at Boston Medical Center, click here.