While breast cancer occurs at similar rates among Black and White women (and in some cases, incidence is higher among White women), Black women in both St. Louis City and County die from breast cancer at higher rates than White women.

• Black women ages 35 to 44 are nearly four times more likely to die from breast cancer than White women in the same age range.

Late-stage diagnoses are significantly more common in low-income and predominantly Black ZIP codes, with some areas reporting up to 44% of cases diagnosed at later stages.

• Black women experience higher rates of delayed treatment initiation (over 60 days post-diagnosis). Women in North County are more likely to begin treatment later than recommended.
• Screening rates in affluent, predominantly White ZIP codes range from 60–84%. In low-income, predominantly Black communities, rates drop as low as 30–39%.

The St. Louis region has 64 accredited mammography units using advanced 3D tomosynthesis technology, far exceeding national benchmarks.

The region also has a highly specialized workforce, with 70% of radiologists fellowship-trained in breast imaging and 81% primarily focused on breast care.

Only 30% of screening facilities offer Saturday hours, typically limited to half days. Just 6% provide any evening appointments, and none offer Sunday hours. Less than half of sites allow walk-in appointments.

Improving breast cancer outcomes in St. Louis requires a fundamental shift in how the region’s existing resources are organized and deployed toward a coordinated, patient-centered system.

Gateway to Hope identified five priority areas:

1. Aligning existing resources with patient needs
2. Expanding access through extended hours as well as improved scheduling and transportation solutions
3. Strengthening care coordination to reduce fragmentation and delays
4. Investing in community engagement to increase screening uptake and trust
5. Building ongoing data-sharing systems to track progress and drive accountability