Geographic Access and the Use of Screening Mammography

Abstract

Background Screening mammography rates vary geographically and have recently declined. Inadequate mammography resources in some areas may impair access to this technology. We assessed the relationship between availability of mammography machines and the use of screening. Methods The location and number of all mammography machines in the US were identified from US Food and Drug Administration records of certified facilities. Inadequate capacity was defined as <1.2 mammography machines per 10,000 women aged 40 or older, the threshold required to meet the Healthy People 2010 target screening rate. The impact of capacity on utilization was evaluated in two cohorts: female respondents age 40 or older to the 2006 Behavioral Risk Factor Surveillance System survey (BRFSS) and a 5% nationwide sample of female Medicare beneficiaries age 65 or older in 2004–2005. Results About 9% of women in the BRFSS cohort and 13% of women in the Medicare cohort lived in counties with <1.2 mammography machines per 10,000 women age 40 or older. In both cohorts, residence in a county with inadequate mammography capacity was associated with lower odds of a recent mammogram (adjusted odds ratio [AOR] in BRFSS: 0.89, 95% CI 0.80 – 0.98, p<0.05; AOR in Medicare: 0.86, 95% CI 0.85 – 0.87, p<0.05), controlling for demographic and health care characteristics. Conclusion In counties with few or no mammography machines, limited availability of imaging resources may be a barrier to screening. Efforts to increase the number of machines in low-capacity areas may improve mammography rates and reduce geographic disparities in breast cancer screening.

Characteristics of US Counties with No Mammography Capacity

“…Similar to an earlier examination of national mammography capacity, our findings indicate that capacity is not distributed equally across counties [18] and that 870 (27.7 %) counties have zero capacity. Although the number of mammography facilities and machines decreased slightly between 2003 and 2009, the percentage of zerocapacity counties remained fairly consistent.…”

“…Several studies comparing screening prevalence to availability of mammography facilities using data from the Behavioral Risk Factor Surveillance System (BRFSS) found that unavailability of mammography facilities may be a barrier to screening [18,36]. We could not provide a direct assessment of the relationship between screening utilization as reported in the BRFSS and the availability of screening facilities from the FDA because of BRFSS data limitations.…”

“…Although the capacity was judged to be nationally adequate, one-fourth of counties had no mammography capacity [17]. Additional research has shown that the lack of imaging resources in the US may be a barrier to screening [18] as well as being associated with a later breast cancer stage at diagnosis [19].…”

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

“…The goal of an organized mammography screening program is to offer high level medical care to every woman at a reasonable expense. Previous studies have shown barriers to entry into the health system for low income women and women in an area with inadequate mammography capacity, resulting in delays in diagnosis (Elkin et al, 2010;Maly et al, 2011). Providing mobile mammography services with community organizations, can be effective in increasing access and decreasing barriers to screening hard-to-reach populations.…”

Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

“…14 Importantly, residents in communities with a lower mammography capacity have lower rates of screening mammograms. 15 Whether similar population-level factors impact riskbased screening uptake and medical care among childhood cancer survivors is not known. Thus, this study was designed to evaluate the role of population-level socioeconomic and health system factors on childhood cancer survivors' riskbased medical care and screening practices, independent of individual-level factors.…”