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Interventions Addressing Breast Cancer 
Mammography Screening Barriers in 
Non-Hispanic Black Women: 
An Integrative Review 
Debra A. Neblett1*, Wanda M. Williams  

 School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA 

*Corresponding author: Debra A. Neblett, Email: daneblet@uncg.edu 

ABSTRACT 
Breast cancer disparity in non-Hispanic Black women is a major concern due to higher breast cancer 
death rates in this population. This integrative review explores interventions aimed at addressing barriers 
to screening mammography in this population. A literature search was conducted of full-text, peer-
reviewed articles published over ten years between 2013-2023 using the Cumulated Index of Nursing and 
Allied Health and PubMed. Of the 396 articles identified, nine met the inclusion criteria. The studies 
identified used various strategies to implement screening interventions in non-Hispanic Black women that 
were culturally tailored and considered social determinants of health, barriers to breast cancer screening, 
community engagement, and patient navigation. These findings suggest that focused interventions 
should consider the challenges to non-Hispanic Black women to schedule and complete mammogram 
screenings. Future research is recommended to conduct interventional studies with non-Hispanic Black 
women specifically tailored to meet their needs to promote engagement in the recommended 
mammography screening guidelines. 

KEYWORDS: breast cancer screening, mammography, interventions, Black or African American, or 
non-Hispanic Black women. 

Citation: Neblett D et al (2023). Interventions Addressing Breast Cancer Mammography Screening Barriers 
in Non-Hispanic Black Women: An Integrative Review. Cancer Health Disparities 7:e1-e11. 
doi:10.9777/chd.2023.1005 
 

 

  

mailto:daneblet@uncg.edu


 
 
 
 
 

 
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INTRODUCTION 
In the United States breast cancer disparity in non-
Hispanic Black women is evident with little 
improvement noted in reducing the gap between 
non-Hispanic Black women and White women. The 
incidence of breast cancer is higher in White 
women. Still, Black women have a higher chance of 
developing breast cancer before age 40 and are 
more likely to die from breast cancer (American 
Association of Cancer Research Steering 
Committee, 2022; The American Cancer Society 
Medical and Editorial Content Team, 2023). Breast 
cancer mortality rates among non-Hispanic Black 
women are 29.2 deaths per 100,000 persons 
compared with 20.6 deaths per 100,000 persons 
among White women (The American Cancer 
Society Medical and Editorial Content Team, 2023). 

Non-Hispanic Black women are more likely to be 
diagnosed with late-stage breast cancer (Giaquinto 
et al., 2022 & McDowell, 2022). Mammography 
screening is effective for early detection, which has 
led to decreased mortality and improved survival. In 
2019, 70.8% of Black women 40 and over reported 
having a mammogram within the past two years 
(National Center for Health Statistics (US), 2023). 
Along with this gradual improvement over the last 
several years, barriers to mammograms still exist. A 
recent qualitative study among non-Hispanic Black 
women identified the following barriers to 
mammogram screening in non-Hispanic Black 
women: fear of pain associated with the procedure, 
inability to make time (not a priority), 
socioeconomic status, employment constraints, lack 
of childcare, and lack of transportation (Williams & 
Fu, 2023). Some system barriers were identified as 
lack of or inadequate insurance, misconceptions 
about the mammogram procedure, poor 
communication from the medical provider, 
mammograms at under-resourced facilities, and a 

lag in routine screening mammograms and follow-
up of abnormal results (Giaquinto et al., 2022 & 
Williams & Fu, 2023). A study by Guo et al. (2019) 
also supported most of these barriers identified 
above as the reason for inconsistent mammogram 
screening in non-Hispanic Black women. Therefore, 
this integrative review examines the current 
literature regarding breast cancer screening 
interventions to address barriers to mammography 
utilization in on-Hispanic Black women. 

METHODS 
A literature search was conducted of full-text, peer-
reviewed articles published over ten years between 
2013-2023 using CINAHL and PubMed. Search 
terms were breast cancer, breast neoplasm, 
mammogram, mammography, interventions or 
strategies or best practices, faith-based, mobile, 
and navigation. The following inclusion criteria were 
used to identify studies in this integrative review: 
women who identified as non-Hispanic Black or 
African American, greater than 18 years of age, 
intervention studies (randomized and non-
randomized) with reported mammogram 
outcomes conducted in the United States. Gray 
literature was not included in this review. The 
authors independently identified all the articles 
selected using the inclusion criteria. Clarification of 
articles selected for inclusion was resolved through 
discussion and consensus of both authors. 

Search Results 
The database searches resulted in 396 articles, and 
after duplicates were removed, 168 articles 
remained, which were further reduced to 9 articles 
based on the inclusion criteria. The integrative 
review process was guided by the Preferred 
Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) diagram and is presented in 
Figure 1. 

Figure 1. Flow Diagram for Inclusion and Exclusion of Studies. 



 
 
 
 
 

 
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RESULTS 
Table 1 provides an overview of the studies included 
in this integrative review. They are listed in 
chronological order of publication date with the 
author(s), study design and timeframe, study 
objective, sample, and outcomes. Six of the nine 
studies were conducted in the Southeast (Gathirua-
Mwangi et al., 2016; Hatcher et al., 2016; Khaliq et 
al., 2017; Mayfield-Johnson et al., 2016; Mosavel & 
Genderson, 2016; Richman et al., 2020), three 

studies in the Midwest (Allgood et al., 2018; Drake 
et al., 2015; Gathirua-Mwangi et al., 2016), and one 
in the Northeast (Hendren et al., 2014). Three 
studies were randomized-control trials, two were 
pilot studies, and four were non-randomized 
intervention studies. The average ages of the 
women in the studies ranged from 40- 69 years old. 
In five out of nine studies, 46-81% of the women 
were uninsured. Studies reported various locations 
for mammogram completion, such as hospitals, 

Reports assessed for eligibility 
(n =10) 

Records identified through 
CINAHL (n = 262, and PubMed 

(n = 134) 
Total (n = 396) 

Records screened 
(n = 168) 

Reports sought for retrieval 
(n = 11) 

Studies included in the review 
(n = 9) 

Reports excluded: (n =1) 
Study did not meet the 

inclusion criteria 

Records removed before 
screening: 

Duplicate records removed 
(n = 228) 

Records excluded 
(n =157) 

Studies did not meet the 
inclusion criteria 

Reports not retrieved 
(n =1) 

Only abstract available 

Identification of studies via databases 
 

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imaging centers, healthcare provider offices, and 
community clinics. In three of the nine studies, 
mammogram completion was self-reported, 
limiting access for future comparisons or follow-up 
of abnormal findings. A study found that women 
who received a recommendation from their 

medical provider were more likely to obtain a 
mammogram (Gathirua-Mwangi et al., 2016). About 
66% of the studies in the review used multiple 
intervention strategies to engage participants in 
deciding to obtain a screening mammogram. 

Table 1. Overview of Studies for this Integrative Review. 

Year, 
Author 

Study Description 
and Study 
Timeframe 

Objective Sample Outcome 

2014 
Hendren 
et al. 

Randomized 
Control Trial April 
to September 2010 

To assess an intervention 
to increase cancer 
screening (*breast and 
colon) among patients in 
a safety-net primary care 
practice.  

n =366 
Control group (usual 
care) 
n =185 
Intervention group 
n =181 
*Breast Cancer 
Screening (intervention 
and control group 
numbers were not 
reported separately) 
n = 126 women  
Age range 40-60+ 
41% African American  

Breast and colon cancer 
intervention and control 
group results were reported 
separately. Mammography 
completion: Overall, the 
sample was 29.7% in the 
intervention group and 
16.7% in the control group. 
African American was 27.7% 
in the intervention group 
and 10.5% in the control 
group. 

2015 
Drake et al. 

Non-Randomized 
Intervention Study 
2009-2011 

To implement patient 
navigation in a high-need 
area to identify women 
due or overdue for a 
mammogram and 
increase mammography 
utilization in this 
population. 

n = 792 women 
Age range 40-69 
89.3 % African 
American 

Mammography completion 
in the women (n = 710) who 
received navigation was 
87.2% (n = 655) of the 
women who were navigated 
and includes 55 women 
who had repeat 
mammograms in year 2 of 
the study. 

2016 
Gathirua-
Mwangi et 
al. 

Randomized 
Control Trial 
2007-2009 

To compare the effects of 
two interventions with 
usual care on 
mammography 
adherence among a 
subsample of African 
American women. 

n = 244 
Usual care (n = 72) 
- mean age 50.6 
DVD (n = 87) 
- mean age 51.3 
Telephone (n = 85) 
- mean age 51.7 

Mammography completion: 
Usual care – 35.2% 
DVD – 41% 
Telephone – 42.2% 

2016 
Hatcher et 
al.  

Randomized 
Control Trial 
2010-2013 

To test the efficacy of a 
pilot intervention to 
increase mammography 

n = 96 
Mean age 51.9 
(Age range 40-83) 

Of the retained participants 
(n = 62) who received one 
of the interventions, one-



 
 
 
 
 

 
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utilization among African 
American women 
recruited from those 
waiting in the ED. 

Control group (n = 33) 
Brochure only (n = 30) 
Motivation interview  
(n = 33) 

quarter (27%) reported 
having a mammogram 
during the study or in the 
preceding three months. 

2016 
Mayfield-
Johnson et 
al. 

Non-Randomized 
Intervention 
Study/ One year 

To increase the relatively 
low screening rate for 
African American women 
in the Mississippi Delta 
through partnerships with 
community-based 
organizations, state health 
departments, and 
academia. 

n = 554 women 
Age range 40 - >65 
94.72% African 
American 

Mammography completion: 
n = 554 
Screening mammogram – 
90.43% 
Diagnostic mammogram – 
9.57% 

2016 
Mosavel et 
al. 

Pilot study 
Not included 

To report on findings 
from a community-based 
study that assessed the 
feasibility of upward 
communication by 
adolescent females to 
influence their female 
family members to obtain 
recommended breast and 
cervical cancer screenings 
or to consult with their 
doctor regarding their 
need for a colonoscopy. 

African American 
women and 
adolescent females  
48 dyads (n = 96) 
completed baseline 
interviews and 
36 dyads completed 
the exit interviews 
Mean age 52 for 
women  
Mean age 15 for 
adolescent females 
Control Group 
n = 14 
Intervention group 
n = 22 

Mammography completion 
– Self-reported: 
Control group – 2 of the 
seven (29%) reported 
receiving a mammogram. 
Intervention group - 5 
(42%) reported making 
appointments, and 5 
obtained a mammogram. 

2017 
Khaliq et al.  

Prospective 
intervention pilot 
study 
October 2012 – 
March 2013 

To evaluate whether an 
intervention that includes 
breast cancer screening 
education during a 
hospital stay and 
scheduling an outpatient 
mammography 
appointment before 
hospital discharge would 
improve adherence to 
mammography screening. 

n = 30 women 
Mean age 57.8 
57% African American 
(n = 17) 

Mammography completion: 
10 women (2 were African 
American), and five needed 
additional imaging and 
follow-up. 

2018, 
Allgood et 
al.  

Non-Randomized 
Intervention Study 
September 2011-
May 2015 

To assess the 
effectiveness of the 
mammogram party in 
increasing mammography 

n = 3,003 women 
< 40 (11%) 
> 40 (88%) 
49% African American 

Mammography completion 
in mammogram parties 
(65.8%) was comparable to 
standard one-on-one 



 
 
 
 
 

 
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uptake, particularly 
among under-served 
populations. 

navigation (63.7%) but is 
less labor-intensive than 
one-on-one navigation. 

2020 
Richman et 
al. 

Non-Randomized 
Intervention Study 
2015-2017 

To outline program 
outcomes in relation to 
the educational 
component of the 
program across 
a two-year period. 

n = 735 women 
Mean age 48 
23% African American 
 

All women were educated 
on breast cancer; 365 
women were navigated and 
assessed for breast health 
needs; 299 were either 
recommended for a clinical 
breast exam or 
mammogram. 
193 women (65%) were 
recommended for a 
mammogram. 
139 women (72%) received 
mammograms (data was 
not separated by race). 

2016 
Mosavel et 
al. 

Pilot study 
Not included 

To report on findings 
from a community-based 
study that assessed the 
feasibility of upward 
communication by 
adolescent females to 
influence their female 
family members to obtain 
recommended breast and 
cervical cancer screenings 
or to consult with their 
doctor regarding their 
need for a colonoscopy. 

African American 
women and 
adolescent females 48 
dyads (n = 96) 
completed baseline 
interviews and 
36 dyads completed 
the exit interviews 
Mean age 52 for 
women Mean age 15 
for adolescent females 
Control Group 
n = 14 
Intervention group 
n = 22 

Mammography completion 
– Self-reported: 
Control group – 2 of the 
seven (29%) reported 
receiving a mammogram. 
Intervention group - 5 
(42%) reported making 
appointments, and 5 
obtained a mammogram.  

2017 
Khaliq et al.  

Prospective 
intervention pilot 
study 
October 2012 – 
March 2013 

To evaluate whether an 
intervention that includes 
breast cancer screening 
education during a 
hospital stay and 
scheduling an outpatient 
mammography 
appointment before 
hospital discharge would 
improve adherence to 
mammography screening. 

n = 30 women 
Mean age 57.8 
57% African American 
(n = 17) 

Mammography completion: 
10 women (2 were African 
American), and five needed 
additional imaging and 
follow-up. 



 
 
 
 
 

 
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2018, 
Allgood et 
al.  

Non-Randomized 
Intervention Study 
September 2011-
May 2015 

To assess the 
effectiveness of the 
mammogram party in 
increasing mammography 
uptake, particularly 
among under-served 
populations. 

n = 3,003 women 
< 40 (11%) 
> 40 (88%) 
49% African American 

Mammography completion 
in mammogram parties 
(65.8%) was comparable to 
standard one-on-one 
navigation (63.7%) but is 
less labor-intensive than 
one-on-one navigation. 

2020 
Richman et 
al. 

Non-Randomized 
Intervention Study 
2015-2017 

To outline program 
outcomes in relation to 
the educational 
component of the 
program across 
a two-year period. 

n = 735 women 
Mean age 48 
23% African American 

All women were educated 
on breast cancer; 365 
women were navigated and 
assessed for breast health 
needs; 299 were either 
recommended for a clinical 
breast exam or 
mammogram. 
193 women (65%) were 
recommended for a 
mammogram. 
139 women (72%) received 
mammograms (data was 
not separated by race). 

 

Highlighted Components of Interventional 
Studies 
Early detection of breast cancer reduces breast 
cancer mortality, and screening mammography is 
essential in addressing the health disparities 
experienced by non-Hispanic Black women who 
experience poorer health outcomes. Black women 
are 40 percent more likely to die from breast cancer 
and be diagnosed with aggressive cancers at 
younger ages (National Center for Health Statistics, 
2023). Due to this finding, the 2023 U.S. Preventive 
Services Taskforce now recommends that Black 
women start screening at age 40. However, this 
change may not be enough to improve health 
inequities, but it is a crucial first step. Additionally, 
healthcare providers are vital in supporting patients 
through conversations about routine 

mammography screening and timely follow-up and 
treatment when indicated (U.S. Preventive Services 
Taskforce, 2023). Implementing interventions 
focused on the specific needs of non-Hispanic Black 
women is essential to address the barriers 
impacting breast cancer screening practices among 
this population. 

The specific interventions identified by this 
integrative review are summarized in Table 2. The 
interventions can be grouped or labeled under five 
areas: culturally tailored, social determinants of 
health, barriers to breast cancer screening, 
community engagement, and patient navigation. 
Some of the most successful programs focused on 
lay and community health workers and the 
importance of a patient navigator. 

 

 



 
 
 
 
 

 
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Table 2. Highlighted Components of Interventional Studies. 

Culturally Tailored 
Interventions 

Social Determinants 
of Health 

Barriers to Breast Cancer 
Screening Addressed 

Engaging 
Community 

Patient Navigation 

Hatcher et al., 2016 Hendren et al., 2013 
Access to care 

Drake et al., 2015 
Resources to assist with 
the cost of mammogram 

Hatcher et al., 
2016  
Lay health workers 

Drake et al., 2015 

Mayfield-Johnson et 
al., 2016 
 
 
 
Richman et al., 2020 

Hatcher et al., 2016 
Access to care 

Khaliq et al., 2017  
Gift card (incentive) to 
offset transportation costs 
to mammogram 
 
Allgood et al., 2018 
Transportation provided 

Mayfield-Johnson 
et al., 2016 
Community Health 
Workers 
 
Richman et al., 
2020  
Lay breast health 
educators 

Hatcher et al., 2016 
 
 
 
Khaliq et al., 2017 

  Richman et al., 2020 
Transportation provided 

 Allgood et al., 2018 

 

Culturally tailored interventions were found to be 
important to improve mammogram screening for 
non-Hispanic Black women. For example, a 
brochure developed from focus groups with Black 
women in the emergency department (ED) was 
used to increase mammography in Black women 
who presented to the ED for non-urgent complaints 
(Hatcher et al., 2016). Mayfield-Johnson et al. (2016) 
described the use of multiple culturally targeted 
strategies in the use of media, community-based 
education, healthcare assistance, and use of 
community health workers. Another study used the 
Pitt County Breast Wellness Initiative-Education 
(PCBWI-E), using Latina and Black community 
members to educate the participants (Richman et 
al., 2020). 

Understanding how other associated barriers, such 
as social determinants of health, affect non-
Hispanic Black women’s access to care is critical. 
Interventions in two studies provided community 
resources for the uninsured or underinsured, where 

participants were provided free or reduced-cost 
screening services or assistance with co-pays 
through various payment sources (Drake et al., 
2015; Hatcher et al., 2016; Hendren et al., 2014). 
Transportation to imaging centers is reported as a 
common barrier to mammography screening 
(Miller et al., 2019). Four of the nine studies 
addressed this barrier by offering gift cards for 
transportation or providing transportation either to 
or from the imaging center or both (Allgood et al., 
2018; Drake et al., 2015; Khaliq et al., 2017; Richman 
et al., 2020). 

The Breast Cancer and Cervical Early Detection 
program provides mammograms for uninsured 
women. Hendren and colleagues (2014) provided 
information about this program to the participants 
as part of the study’s intervention, but no outcomes 
were reported on where mammograms were 
obtained. Breast and Cervical Cancer Control 
Program was one of three mammogram sites in a 
study evaluating a community-based breast cancer 



 
 
 
 
 

 
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prevention that allowed for tracking mammogram 
completion. However, locations for screening were 
not reported individually (Richman et al., 2020). 

A third factor was using multiple intervention 
strategies, which can reduce barriers to cancer 
screening. One randomized controlled trial mailed 
letters and used automated telephone calls in the 
intervention group versus the usual care in the 
control group to remind African American women 
about obtaining a mammogram. There was a 
higher completion rate in the intervention group in 
this study (Hendren et al., 2014). Other interventions 
included breast health education by community 
health workers, mammogram scheduling, and 
follow-up and treatment services if indicated 
(Mayfield-Johnson et al., 2016). Richman and 
colleagues (2020) incorporated various 
interventions that were culturally tailored, 
addressed barriers to breast cancer screening, and 
engaged the community. 

A fourth factor was the importance of support and 
education within the community. Three studies 
engaged community members through lay health 
workers, community health workers, and lay breast 
health educators (Hatcher et al., 2016; Mayfield-
Johnson et al., 2016; Richman et al., 2020). 
Community health workers were recruited from the 
community where the research would occur. They 
served as gatekeepers due to their familiarity with 
the needs and health issues of the community. 

Lastly, patient navigation was identified in four 
studies (Allgood et al., 2018; Drake et al., 2015; 
Hatcher et al., 2016; Khaliq et al., 2017). The patient 
navigator’s tasks varied. Some of the duties 
included educating women about breast health and 
breast cancer, identifying women who need 
mammograms, scheduling mammograms, 
assessing for any barriers to adherence, assisting 
with resources to address these barriers, supporting 

women regarding the results, and following up on 
abnormal mammography results (Allgood et al., 
2018; Drake et al., 2015; Hatcher et al., 2016; Khaliq 
et al., 2017; Richman et al., 2020). One study 
compared navigation using a mammogram party 
versus one-on-one navigation and found 
comparable completion rates. However, 
mammogram parties can foster a sense of 
community among the women and provide 
support within the party members through the 
shared experience of having a mammogram on the 
same day. More mammograms can be completed 
in mammogram parties versus one-on-one 
navigation. This same study reported a range of 
total navigation contacts of 10.9 in women invited 
to a mammogram party and 15.0 in women not 
invited to a party (Allgood et al., 2018). Patient 
navigation was first used to address barriers in 
cancer care in 1990 and continues to have support 
as an effective strategy to promote early detection 
and treatment (Stringer-Reasor et al., 2021). 

DISCUSSION 
Mammography screening is an effective tool for 
early detection of breast cancer and a means to 
improve the health outcome of non-Hispanic Black 
women. Breast cancer disparity gaps that are still 
prevalent today must be addressed to reduce this 
population's higher breast cancer death rate. 
Healthcare providers must recognize and be willing 
to improve how they relate and communicate with 
non-Hispanic Black women, which could foster 
better adherence to mammogram screening. A free 
CME toolkit, “Talking to Patients about Breast 
Cancer Screening,” on the American College of 
Radiology website is available for healthcare 
providers. The toolkit includes clinical decision aids, 
education handouts about breast cancer, 
infographics, and clinical education videos 
(American College of Radiology, n.d.). In addition, a 
study by Fung et al. (2021) supports that more 



 
 
 
 
 

 
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culturally and linguistically targeted education is 
needed to increase mammogram screening among 
non-Hispanic Black women. 

The healthcare community should consider 
challenges to breast cancer screening for non-
Hispanic Black women, such as childcare, and 
incorporate effective measures to address this issue. 
Taking time off from work is a significant concern. 
Offering screening schedules in the evening or on 
weekends so women would not have to lose 
income from taking time off from work could 
improve non-Hispanic Black women’s adherence to 
screening. Consideration of these interventions is 
needed to reduce the higher breast cancer death 
rates in non-Hispanic Black women. Other issues to 
address breast cancer screening disparities are 
advocating for affordable health insurance, 
supporting safety-net facilities that provide breast 
cancer screening, and partnering with leaders in 
healthcare systems for mammography and patient 
navigation services (Stringer-Reasor et al., 2021). 

There are limitations to consider in this integrative 
review. Barriers to early detection of breast cancer 
are multifaceted. This review focused on 
interventions addressing barriers to mammography 
screening in non-Hispanic Black women, which did 
not allow for comparison. The studies' 
socioeconomic and insurance status varied, with 
many uninsured participants. The long-term effects 
of the interventions are not known. Breast cancer 
diagnosis, treatment, and survivorship were not 
included. Despite these limitations, the review 
highlighted strategies to address barriers to 
mammography screening in non-Hispanic Black 
women. 

The findings from this review emphasize the 
significance of accepting, understanding and 
addressing the cultural differences and the multi-
level barriers (social determinants of health) that 

contribute to a non-Hispanic Black woman not 
being able to or not obtaining a mammogram as 
recommended. In addition, the 2023 U.S. Preventive 
Services Taskforce now recommends that Black 
women start screening at age 40. Future studies 
should consider incorporating measures to track 
mammogram completion versus self-reporting. 
More longitudinal interventional studies tailored to 
non-Hispanic Black women are needed to support 
their engagement in mammogram screening 
guidelines for early detection of breast cancer. 

Acknowledgments 
The authors thank Dr. Debra Wallace for her 
editorial support. 

Author Contributions 
Conception and plan for integrative review: DN and 
WW. 
Initial manuscript writing, review, and revisions: DN 
and WW. 

Conflict of Interest 
The authors declare that they have no conflicts of 
interest with the contents of this article. 

Funding 
There was no funding support for this integrative 
review. 

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https://www.acr.org/Clinical-Resources/Breast-Imaging-Resources/Mammography-CME-Toolkit
https://www.acr.org/Clinical-Resources/Breast-Imaging-Resources/Mammography-CME-Toolkit

	INTRODUCTION
	METHODS
	Search Results

	RESULTS
	Highlighted Components of Interventional Studies

	DISCUSSION
	Acknowledgments
	Author Contributions
	Conflict of Interest
	Funding

