Geographic Access to Breast Imaging for US Women

Abstract

Background The breast imaging modalities of mammography, ultrasound, and magnetic resonance imaging (MRI) are widely used for screening, diagnosis, treatment, and surveillance of breast cancer. Geographic access to breast imaging modalities is not known at a national level overall or for population subgroups. Methods A retrospective study of 2004-2008 Medicare claims data to identify ZIP codes in which breast imaging occurred, and data were mapped. We estimated travel times to each modality for 215,798 census block groups in the contiguous U.S. Using Census 2010 data, we characterized travel times by socio-demographic factors for 92,788,909 women aged ≥30 years, overall, and by subgroups of age, race/ethnicity, rurality, education, and median income. Results Overall, 85% of women had travel times of ≤20 minutes to nearest mammography or ultrasound, and 70% had travel times of ≤20 minutes for MRI with little variation by age. Native American women had median travel times 2-3-fold longer to all three modalities, compared to women of other racial/ethnic groups. For rural women, median travel times to breast imaging were 4-8-fold longer than for urban women. Black and Asian women had shortest median travel times to all three modalities. Conclusion Travel times to mammography and ultrasound breast imaging are short for most women, but to breast MRI travel times are notably longer. Native American and rural women are disadvantaged in geographic access based on travel times to breast imaging. This work informs potential interventions to reduce inequities in access and utilization.

Racial/Ethnic Health Disparities Among Rural Adults — United States, 2012–2015

“…Rural communities often are less racially and ethnically diverse than urban areas ( 1 ), have worse health outcomes ( 2 , 3 ), and have less access to care ( 4 ). Although less heterogeneous than urban areas, the demographic composition of rural communities is becoming more diverse, driven in large part by populations that have not historically lived in rural communities ( 1 , 5 ).…”

Use of Preoperative Magnetic Resonance Imaging for Breast Cancer

“…described rapid expansion of breast pMRI use in the United States, 4,5,[19][20][21] ranging from a 3-4 to 20-fold 5 increase in the past 10 years. To our knowledge, there are no large-scale studies demonstrating the potential associated downstream negative consequences associated with pMRI in routine clinical practice.…”

What Does a Shoulder MRI Cost the Consumer?

“…Next, we found geographic variations in costs by comparing urban, rural, and critical access hospital status as defined by the CMS [4]. Previous studies have suggested that access to care for advanced imaging is a concern for rural and critical access hospitals [16,17,22], which may be directly attributable to the relatively high cost of purchasing and maintaining advanced imaging modalities in low-utilization areas [26]. Urban-rural discrepancies in the orthopaedic workforce have been noted previously, with fewer orthopaedic surgeons practicing in rural areas of the country which might affect access to quality orthopaedic care in these areas [11].…”