OBJECTIVE: Psychological distress impairs the cognitive function involved in planning and decision-making (executive cognitive function), and hinders engagement in health promoting behaviors. This study examined the relationship among distress, executive cognitive function (ECF) and mammography use in African American women at risk for breast cancer. DESIGN: A cross-sectional sample of mammography screening adherers (n = 44) and non-adherers (n = 16) completed measures of psychological distress (Brief Symptom Inventory) and executive cognitive function, (Wisconsin Card Sort Task and Stroop Color Word Test). RESULTS: More than one-quarter of the high-risk sample had high levels of distress. Distress scores explained 12% of the variance in two ECF components (abstract concept formation and cognitive flexibility), suggesting a significant relationship between psychological distress and cognitive function. Distress scores and ECF measures did not predict mammography use; employment status emerged as the strongest predictor of mammography screening (OR = 4.36, 95% CI: 1.18-16.07). CONCLUSION: Elevated psychological distress is evident in high-risk African American women and appears to have an effect on the cognitive function involved in behavioral regulation and planning. Results also support the role of socioeconomic status as a significant predictor of mammography use.