Investigators revealed that the travel time to the nearest mammography facility may be long for a considerable proportion of patients in the United States, particularly affecting more than 50% of patients in the rural areas of 28 states, according to a new study published by Wiese et al in the Journal of the National Cancer Institute. The poor geographic accessibility uncovered in the findings was associated with a lower number of patients getting important breast cancer screenings.
“Our findings are concerning. Mammography is widely available in the United States, but barriers, such as long drive times, are likely influencing a [patient’s] decision to get screened,” stressed lead study author Daniel Wiese, PhD, Adjunct Assistant Professor of Geography and Urban Studies at Temple University, and a senior scientist in the Cancer Disparities Research program in the Department of Surveillance and Health Equity Science at the American Cancer Society. “We need to move forward on programs to remove these barriers so [patients] can access this potentially life-saving screening.”
For the study, the investigators obtained mammography location data in the contiguous United States in 2006 and 2022. They estimated the number and proportion of patients aged 45 to 84 years who had limited travel-time–based geographic accessibility—a drive time greater than 20 minutes—to the nearest mammography facility by urban-rural status and state from 2006 to 2022. The investigators then evaluated associations between limited accessibility and breast cancer screening prevalence by state.
The results showed, nationwide, that the proportion of patients with limited accessibility to mammograms remained high. This proportion did not substantially change from 12.7% in 2006 to 12.2% in 2022; however, because of population growth, the estimated number of patients with limited accessibility increased from 7.5 million in 2006 to 8.2 million in 2022. In 10 states, the data showed that more than 26% of patients had limited accessibility to mammograms, primarily in regions of the Rocky Mountains and the South. Except for several states in the New England and Mid-Atlantic regions, limited accessibility to mammograms was substantial in rural areas—greater than 50% in 28 states—with the highest proportions in the Rocky Mountains region. In urban areas, this proportion was less than 5% in 35 states. The largest improvements were in South Dakota and Mississippi, where limited accessibility declined by 5.1% and 4.8%, respectively.
“The simple answer would be to open more breast cancer screening facilities in sparsely populated areas, but this can be economically and logistically challenging,” added Dr. Wiese, concluding that “Providing transportation or promoting the use of mobile screening units may be alternative actions, although further research is needed to improve the effectiveness of mobile screening units in increasing participation in breast cancer screening in rural areas.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
