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This study identifies factors associated with screening mammography utilization for Latina women age 40 and older in two Massachusetts cities, who are predominantly of Caribbean origin. It is a cross-sectional survey based on an area probability sample, using bilingual Latina interviewers. Sixty-one percent of the sample was Latina, 99% of whom were interviewed in Spanish. Ethnicity, educational attainment, and acculturation were unrelated to recent screening. While distinct healing traditions were found among some Latinas, their use was unrelated to screening. Higher fatalism scores had a bivariate association with lower probability of screening. In a logistic regression, predictors were having health insurance or access to free care; having discussed mammography with a physician in the past 2 years; the difference between 67 and respondent's age (negative coefficient); and city of residence. Having a regular source of care was a predictor when substituted for insurance status. Insurance status and age principally determine whether subjects are screened, mediated by access to physician services and whether physicians recommend screening. Results suggest that universal medical insurance, and efforts to influence physician practices, are key to promoting screening mammography among this population. [ABSTRACT FROM AUTHOR]