Geographic barriers limit access to screening mammography more in rural vs. urban areas

Long travel times to facilities offering mammography substantially limited accessibility to breast cancer screening, particularly for women living in rural areas, according to data published in the Journal of the National Cancer Institute.

“Our findings are concerning. Mammography is widely available in the United States, but barriers, such as long drive times, are likely influencing a woman’s decision to get screened,” Daniel Wiese, PhD, senior scientist of cancer disparity research at the American Cancer Society, said in a press release. “We need to move forward on programs to remove these barriers so women can access this potentially life-saving screening.”

Study methods

Wiese and colleagues analyzed the FDA’s data on mammography locations in the contiguous U.S. in 2006 and in 2022 as of May 2022 by census tract. They estimated a 20-minute drive time for each census tract using road network data and determined whether mammography was offered in those areas.

The researchers then estimated how many women aged 45 to 84 years had limited accessibility to screening services — defined as living more than 20 minutes from the nearest mammography facility — during 2006 and 2022, as well as evaluated changes over the study period.

Using linear regression models, Wiese and colleagues evaluated the associations between limited access to mammography and state-level breast screening prevalence.

Accessibility, prevalence of screening

The proportion of women with limited accessibility was similar in 2006 and 2022 (12.7% vs. 12.2%). Due to population growth, however, these proportions corresponded with 7.5 million and 8.2 million women, respectively.

Rural areas consistently had higher levels of limited accessibility to mammography services in both 2006 (47.1% vs. 3%) and 2022 (50.6% vs. 3%) compared with urban areas.

In 2022, there were 10 states where more than 26% of women had limited accessibility to mammography, whereas only 1% of women in several Northeastern states had limited accessibility. South Dakota (–6.5%) and Idaho (–5.4%) had the largest declines in accessibility between 2006 and 2022.

In 28 states, more than 50% of women in rural areas had limited accessibility to mammography, with the highest proportions in the Rocky Mountains region. For urban areas, the proportion was no greater than 5% in 35 states with minimal changes over the study period.

The prevalence of being up-to-date on breast cancer screening decreased an average of 1.1% between 2006 and 2018, the most recent year with data available. Notably, a higher proportion of limited mammography accessibility was associated with lower state-level screening prevalence in 2006 (regression coefficient = –0.23; P < .001).

“The proportion of women with limited accessibility to mammography in rural areas declined from 2006 to 2022 in several states, indicating improvements in accessibility to breast cancer screening,” Wiese and colleagues wrote. “On the other hand, a slight increase in this proportion in rural areas in 34 states may be in part due to the ongoing consolidation of screening services in large hospitals and discontinuation of mammography services at small stand-alone facilities.”

Moving forward, more work is needed to increase screening among rural populations, according to the researchers.

“The simple answer would be to open more breast cancer screening facilities in sparsely populated areas, but this can be economically and logistically challenging,” Wiese said in the release. “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.”

References:

• Travel time for breast cancer screening remains long for many women in the U.S., new study shows. pressroom.cancer.org/mammographytraveltimes. Published Dec. 14, 2022. Accessed Dec. 19, 2022.
• Wiese D, et al. J Natl Cancer Inst. 2022;doi:10.1093/jnci/djac217.