BACKGROUND: Mammography screening can reduce breast cancer burden, however it continues to be underutilized by low-income women even though their health insurance provides free mammograms. While a vast majority of eligible women in Tennessee do not receive the free mammograms available to them, 25% of women with comparable backgrounds do. OBJECTIVE: To describe the influences that may have led these women to adhere to mammography screening guidelines in order to develop a case-control study for further research. DESIGN: Healthcare workers conducted personal interviews on mammography knowledge, attitudes, and behaviors. SETTING: In-home. PARTICIPANTS: All were members of the Managed Care Organization Access MedPlus with incomes <200% above poverty. All were adherent to mammography guidelines per medical records. Fifty-eight respondents were Black, 27 were White, and all were at least 40 years old. RESULTS: Participants recognized breast cancer risk factors, warning signs, and the importance of early detection to survival. 75% reported a family history of any cancer type, 77% knew someone who had breast cancer, and 52% knew someone who had died from it. These women expressed that screening strongly reassured them. Willing to work with their doctors, they trust the health system's ability to treat breast cancer and are generally satisfied with their health care. CONCLUSIONS: Repeat regular mammography screening is positively associated with higher knowledge about risk factors, warning signs, screening, and treatment. Trust in the healthcare system, ability to work with physicians, and support by family and friends lead low-income, adhering women to be proactive in seeking mammography screenings.