Geographic access to breast imaging for US women

Tracy Onega, Rebecca Hubbard, Deirdre Hill, Christoph I. Lee, Jennifer S. Haas, Heather A. Carlos, Jennifer Alford-Teaster, Andy Bogart, Wendy B. DeMartini, Karla Kerlikowske, Beth A. Virnig, Diana S.M. Buist, Louise Henderson, Anna N.A. Tosteson

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

PURPOSE: The breast imaging modalities of mammography, ultrasound, and MRI are widely used for screening, diagnosis, treatment, and surveillance of breast cancer. Geographic access to breast imaging services in various modalities is not known at a national level overall or for population subgroups.

METHODS: A retrospective study of 2004-2008 Medicare claims data was conducted to identify ZIP codes in which breast imaging occurred, and data were mapped. Estimated travel times were made for each modality for 215,798 census block groups in the contiguous United States. Using Census 2010 data, travel times were characterized by sociodemographic 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 services, and 70% had travel times of ≤20 minutes for MRI with little variation by age. Native American women had median travel times 2-3 times longer for all 3 modalities, compared to women of other racial/ethnic groups. For rural women, median travel times to breast imaging services were 4-8-fold longer than they were for urban women. Black and Asian women had the shortest median travel times to services for all 3 modalities.

CONCLUSIONS: Travel times to mammography and ultrasound breast imaging facilities are short for most women, but for breast MRI, travel times are notably longer. Native American and rural women are disadvantaged in geographic access based on travel times to breast imaging services. This work informs potential interventions to reduce inequities in access and utilization.

Original languageEnglish (US)
Pages (from-to)874-882
Number of pages9
JournalJournal of the American College of Radiology : JACR
Volume11
Issue number9
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Bibliographical note

Funding Information:
The authors have no financial disclosures related to the funding of this specific project by the NIH. However, Wendy B. DeMartini, MD, receives grant support from both GE Health Care and Phillips Medical Systems.

Funding Information:
This work was supported by the National Institutes of Health , National Cancer Institute Grant Number R01CA149365 , RC2CA148259 , and P01CA154292 . CIL is supported in part by the National Institutes of Health Grant Number L60 MD005349 .

Publisher Copyright:
Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Keywords

  • Travel time
  • access
  • breast imaging
  • disparities
  • mammography

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