Mammography Capacity. Impact on Screening Rates and Breast Cancer Stage at Diagnosis

Background: Mammography capacity in the U.S. reportedly is adequate, but has not been examined in nonmetropolitan areas. This study examined the relationships between in-county mammography facilities and rates of mammography screening and late-stage diagnosis of breast cancers. Methods: The association between a mammography facility in the county of residence (2002-2004) and the odds of screening within 2 years were examined (in 2007) among Texas women aged >40 years who responded to the 2004 Behavioral Risk Factor Surveillance System survey, using multivariate logistic regression to control for age, race, ethnicity, education, income, self-reported health, insurance, and usual source of care. Similarly, the association between an in-county mammography facility and the odds of diagnosis with locally advanced or disseminated disease was examined among Texas women aged >40 years who developed breast cancer in 2004. Results: Half of the 254 counties in Texas had no mammography facility. After controlling for confounding factors, an in-county facility was associated with significantly higher odds of screening (OR=3.27; p=0.03) and lower odds of late-stage breast cancer at diagnosis (OR=0.36; 95% CI=0.26-0.51; p<0.001). The risks of late-stage diagnosis were higher for African-American women (OR=1.52; 95% CI=1.22-1.89; p<0.001) and Hispanic women (OR=1.23; 95% CI=0.99-1.53; p=0.06) than for white women. Conclusions: Although mammography capacity in the U.S. may be adequate on average, the unequal distribution of facilities results in large rural areas without facilities. Screening rates in these areas are suboptimal and are associated with late-stage diagnosis of breast cancer.