Characteristics of US Counties With No Mammography Capacity

Lucy A. Peipins; Jacqueline Miller; Thomas B. Richards; Janet Kay Bobo; Ta Liu; Mary C. White; Djenaba Joseph; Florence Tangka; Donatus U. Ekwueme

Disclosures

J Community Health. 2012;37(6):1239-1248. 

In This Article

Abstract and Introduction

Abstract

Access to screening mammography may be limited by the availability of facilities and machines, and nationwide mammography capacity has been declining. We assessed nationwide capacity at state and county levels from 2003 to 2009, the most recent year for which complete data were available. Using mammography facility certification and inspection data from the Food and Drug Administration, we geocoded all mammography facilities in the United States and determined the total number of fully accredited mammography machines in each US County. We categorized mammography capacity as counties with zero capacity (i.e., 0 machines) or counties with capacity (i.e.,≥1 machines), and then compared those two categories by sociodemographic, health care, and geographic characteristics. We found that mammography capacity was not distributed equally across counties within states and that more than 27 % of counties had zero capacity. Although the number of mammography facilities and machines decreased slightly from 2003 to 2009, the percentage of counties with zero capacity changed little. In adjusted analyses, having zero mammography capacity was most strongly associated with low population density (OR = 11.0; 95 % CI 7.7–15.9), low primary care physician density (OR = 8.9; 95 % CI 6.8–11.7), and a low percentage of insured residents (OR = 3.3; 95 % CI 2.5–4.3) when compared with counties having at least one mammography machine. Mammography capacity has been and remains a concern for a portion of the US population—a population that is mostly but not entirely rural.

Introduction

Screening mammography is currently the most effective way to detect breast abnormalities and has led to an estimated 10–25 % mortality reduction from breast cancer.[1,2] Even as mammography use has reached a plateau in recent years,[3] mammography usage varies by state[4] and a significant proportion of women are not up-to-date with screening, especially low-income women, those who are uninsured[5,6] and those without usual source of care.[7] In November 2009, the US Preventive Services Task Force (USPSTF) recommended that women aged 50 and older undergo routine screening mammography every 2 years.[8] Earlier USPSTF recommendations and those of the American Cancer Society and the American College of Radiology recommended beginning annual screening for women 40 years of age and older.[9,10]

Among the barriers to screening that have been detailed in the literature is access to mammography facilities.[11–15] The conceptual framework describing access to medical services includes a number of related characteristics: availability or supply of services, accessibility or distance to those services, how accommodating and acceptable the services are to individuals, and the affordability of the services.[16] The availability of mammography machines, defined as mammography capacity, is a key component of access. In 2006, the US Government Accountability Office (GAO) issued a report regarding nationwide capacity for mammography from 2001 to 2004 indicating that mammography capacity decreased by 6 %. 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]

For this analysis, we updated the GAO 2006 report and provided a more detailed examination of state- and county-level mammography capacity from 2003 to 2009, the most recent years for which complete data were available. Because a relatively large proportion of counties have no capacity, we further sought to describe and compare the sociodemographic and geographic characteristics of counties with zero mammography capacity (no machines) with those counties having capacity (at least one machine) in order to better understand the factors that underlie disparities in access to mammography.

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