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Liu Z, Kuo YF, Giordano SH. Disparities in screening mammography utilization among Hispanic women in rural Texas from 2002 to 2018. Cancer Causes Control 2023; 34:963-971. [PMID: 37354321 DOI: 10.1007/s10552-023-01738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To examine the trends of racial/ethnic and urban-rural disparities in screening mammography use with a focus on Hispanic women in rural Texas, as well as to further investigate barriers to mammography screening practices. METHODS A serial cross-sectional study was conducted on screening mammography including eligible female respondents (≥ 40 years) from the Texas Behavioral Risk Factor Surveillance System survey from 2002 to 2018. FINDINGS Weighted descriptive analyses showed persistent racial/ethnic and urban-rural disparities in mammography screening rates among eligible women (≥ 40 years) in Texas. Overall, the mammography screening rates for women in rural areas were significantly lower than women in urban areas with a mean rate of 64.09% versus 70.89% (p < 0.001). Rural Hispanic women had the lowest mean mammography screening rate (55.98%) among all eligible women which is 16.27% below the mean mammography screening rate of non-Hispanic white women in urban areas. Weighted logistic regression model revealed that women with no health insurance or primary care providers were 52% (95% Confidence Interval [CI] 0.36-0.63, p < 0.001) or 54% (95% CI 0.35-0.6, p < 0.001) less likely having an up-to-date mammography screening compared with women with health insurance or primary care providers, respectively. CONCLUSIONS Our study demonstrated significant and persistent racial and urban-rural disparities in screening mammography utilization among Hispanic women compared with non-Hispanic white women from 2002 to 2018. Healthcare access is a major contributor to these disparities. It highlights the need for wide-scale interventions from public health and policymakers targeting under screened racial minorities and rural regions population to promote screening mammography services among disadvantaged population.
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Affiliation(s)
- Zhaoli Liu
- College of Nursing and Health Innovation, The University of Texas at Arlington, 411 S. Nedderman Drive, Box 19407, Arlington, TX, 76019, USA.
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
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2
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Davis M, Simpson K, Lenert LA, Diaz V, Alekseyenko AV. Predicting Mammogram Screening Follow Through with Electronic Health Record and Geographically Linked Data. CANCER RESEARCH COMMUNICATIONS 2023; 3:2126-2132. [PMID: 37782226 PMCID: PMC10586236 DOI: 10.1158/2767-9764.crc-23-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/09/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
Cancer is the second leading cause of death in the United States, and breast cancer is the fourth leading cause of cancer-related death, with 42,275 women dying of breast cancer in the United States in 2020. Screening is a key strategy for reducing mortality from breast cancer and is recommended by various national guidelines. This study applies machine learning classification methods to the task of predicting which patients will fail to complete a mammogram screening after having one ordered, as well as understanding the underlying features that influence predictions. The results show that a small group of patients can be identified that are very unlikely to complete mammogram screening, enabling care managers to focus resources. SIGNIFICANCE The motivation behind this study is to create an automated system that can identify a small group of individuals that are at elevated risk for not following through completing a mammogram screening. This will enable interventions to boost screening to be focused on patients least likely to complete screening.
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Affiliation(s)
- Matthew Davis
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Kit Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Leslie A. Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina
- Department of Internal Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Vanessa Diaz
- Department of Family Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Alexander V. Alekseyenko
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina
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3
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Cotes C, Morozova A, Pourhassan S, Aran S, Singh H. Community Outreach in Breast Imaging: What Radiologists Can Do to Close the Gap for the Uninsured Population. Radiographics 2023; 43:e230011. [PMID: 37792594 DOI: 10.1148/rg.230011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
After implementation of the Affordable Care Act in 2010, the uninsured population of the United States decreased significantly. As of 2022, there were approximately 26.4 million uninsured individuals in the United States. The lack of coverage and access to services disproportionally affect minority groups in the country, reflecting the influence of the social determinants of health in their uninsured status. Use of screening mammography, an effective modality that results in early detection of and decreased mortality from breast cancer, was delayed or postponed by women of all races due to lockdowns and fear during the COVID-19 pandemic. Since then, the return to mammographic screening has lagged among minorities, further increasing their disproportionate screening gap. Radiologists-and more specifically breast imagers-must recognize these issues, as people who are uninsured and part of minority groups are diagnosed with breast cancer at later stages and have higher mortality rates, less continuity of care, and overall lower survival. The purpose of this article is to familiarize radiologists with the uninsured population, explain how they are disproportionally affected by breast cancer, and propose strategies that breast imagers can pursue to improve screening access and decrease compliance gaps for this patient population. ©RSNA, 2023 See the invited commentary by Nguyen in this issue. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Claudia Cotes
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Anastasiia Morozova
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Sara Pourhassan
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Shima Aran
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
| | - Harnoor Singh
- From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, Suite 2.010, Houston, TX 77030
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4
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Hansson E, Zaya S, Meyer S, Freiin von Wrangel A, Wärnberg F, Zackrisson S. Prevalence of women with breast implants in Sweden: a study based on the population-based mammography screening programme. J Plast Surg Hand Surg 2023; 58:96-100. [PMID: 37728392 DOI: 10.2340/jphs.v58.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Knowledge about the prevalence of women with breast implants is paramount in calculations of risks and in estimations of effects on screening and breast cancer treatment. Most of the estimations of prevalence made to date are rough and often based on sales data. The main aim of this study was to calculate the prevalence of breast implants in Swedish women. The secondary aim was to investigate if it is feasible to establish the occurrence of breast implants with the help of the public mammography screening programme, in a country with a publicly funded welfare-type healthcare system and with a clear documentation of screening. METHODS Information on implants was prospectively collected from all screening attendants from 1st of February 2022 to 1st of August 2022 based on a question from the radiographer to the woman and later verified on the mammogram. RESULTS During the study period 4,639 women were screened, of which 182 had implants (3.9%). The frequency varies between 1.6 and 6.4% in different age groups. CONCLUSION The prevalence of breast implants in Swedish women is estimated to be around 4%. The population-based mammography screening programme in countries with a publicly funded welfare-type healthcare system and a clear documentation of mammography screening attendance, seems to be a feasible way to establish the prevalence of breast implants in the population. The large number of women with breast implants warrants further studies regarding the best diagnostic and treatment alternatives for this group. Pre-registration: ClinicalTrials.Gov identifier NCT05222100.
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Affiliation(s)
- Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden.
| | - Sarah Zaya
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology and Mammography, Gothenburg, Sweden
| | - Susanne Meyer
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic Surgery, Gothenburg, Sweden
| | - Alexa Freiin von Wrangel
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology and Mammography, Gothenburg, Sweden
| | - Fredrik Wärnberg
- Department of Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden; Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
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Davis M, Simpson K, Diaz V, Alekseyenko AV. Mammogram Uptake from Social Determinants of Health Can Be Lost in Translation to Individual Patients. RESEARCH SQUARE 2023:rs.3.rs-3298459. [PMID: 37693463 PMCID: PMC10491323 DOI: 10.21203/rs.3.rs-3298459/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Purpose The objective of this study is to describe patterns in barriers to breast cancer screening uptake with the end goal of improving screening adherence and decreasing the burden of mortality due to breast cancer. This study looks at social determinants of health and their association to screening and mortality. It also investigates the extent that models trained on county data are generalizable to individuals. Methods County level screening uptake and age adjusted mortality due to breast cancer are combined with the Centers for Disease Controls Social Vulnerability Index (SVI) to train a model predicting screening uptake rates. Patterns learned are then applied to de-identified electronic medical records from individual patients to make predictions on mammogram screening follow through. Results Accurate predictions can be made about a county's breast cancer screening uptake with the SVI. However, the association between increased screening, and decreased age adjusted mortality, doesn't hold in areas with a high proportion of minority residents. It is also shown that patterns learned from county SVI data have little discriminative power at the patient level. Conclusion This study demonstrates that social determinants in the SVI can explain much of the variance in county breast cancer screening rates. However, these same patterns fail to discriminate which patients will have timely follow through of a mammogram screening test. This study also concludes that the core association between increased screening and decreased age adjusted mortality does not hold in high proportion minority areas.
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6
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Funaro K, Niell B. Screening Mammography Utilization in the United States. JOURNAL OF BREAST IMAGING 2023; 5:384-392. [PMID: 38416907 DOI: 10.1093/jbi/wbad042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 03/01/2024]
Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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7
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Grimm LJ. Letter to the Editor - "Is it ethical to incentivize mammography screening in Medicaid populations? - A policy review and conceptual analysis". Prev Med 2022; 154:106568. [PMID: 34974878 DOI: 10.1016/j.ypmed.2021.106568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Lars J Grimm
- Duke University, Dept. of Radiology, Box 3808, 40 Duke Medicine Circle, Durham, NC 27710, USA.
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8
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Lawson MB, Lee CI, Hippe DS, Chennupati S, Fedorenko CR, Malone KE, Ramsey SD, Lee JM. Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes. J Natl Compr Canc Netw 2021; 19:1156-1164. [PMID: 34330103 DOI: 10.6004/jnccn.2020.7801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. PATIENTS AND METHODS Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. RESULTS Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80-4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64-2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10-6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26-3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67-2.61). Nonreceipt of mammography was associated with younger age (40-49 vs 50-59 years; OR, 1.69; 95% CI, 1.45-1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03-1.07). CONCLUSIONS In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- 1Department of Radiology, University of Washington School of Medicine; and
| | - Christoph I Lee
- 1Department of Radiology, University of Washington School of Medicine; and.,2Hutchinson Institute for Cancer Outcomes Research, and
| | - Daniel S Hippe
- 1Department of Radiology, University of Washington School of Medicine; and
| | | | | | - Kathleen E Malone
- 3Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Scott D Ramsey
- 2Hutchinson Institute for Cancer Outcomes Research, and.,3Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janie M Lee
- 1Department of Radiology, University of Washington School of Medicine; and.,2Hutchinson Institute for Cancer Outcomes Research, and
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9
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Roubidoux MA, Richards B, Honey NE, Begay JA. Adherence to Screening Among American Indian Women Accessing a Mobile Mammography Unit. Acad Radiol 2021; 28:944-949. [PMID: 33896716 DOI: 10.1016/j.acra.2021.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES Although screening mammography is essential to reducing breast cancer morbidity and mortality, barriers exist especially among underrepresented minority groups. There are few studies of mammogram screening among American Indian women, many of whom reside in rural areas where screening access is challenging. A mobile mammography unit served 24 Indian Health Service clinics during 2013-17. Screening mammography adherence was evaluated. MATERIALS AND METHODS Among mobile unit women, 'adherence to screening' was determined by the date of the most recent prior mammogram. Those having a prior mammogram 9-27 months ago were classified as 'adherent to screening'. Comparison screening data were obtained from the American College of Radiology National Mammography Database, consisting of screening cases occurring in year 2015. Additionally, among mobile unit women 'continued adherence to screening' was determined, defined as at least one repeat screening at the mobile unit within the subsequent 9-27 months after a screening there. RESULTS Among 1,615 mobile unit women, 624 (38.6%) were adherent to screening. Among 2,509,826 National Mammography Database women, 1,481,021 (59.0%) were adherent to screening. (p<0.0001) The prevalence of a >27-month interval between mammograms was 3.13 (95% CI 2.91-3.36) times greater among mobile unit women than National Mammography Database women. 'Continued adherence to screening' of mobile unit women was 428/1194 (35.9%). CONCLUSION Adherence to screening and continued adherence to screening were low among mobile unit women and time interval between screenings was longer than National Mammography Database women. Factors to improve screening adherence among these underserved women should be determined.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910 Box 5326; 1500 E. Ann Arbor Michigan.
| | | | | | - Joel A Begay
- Senior Research Assistant and Data Analyst Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Monticciolo DL. Current Guidelines and Gaps in Breast Cancer Screening. J Am Coll Radiol 2020; 17:1269-1275. [PMID: 32473894 DOI: 10.1016/j.jacr.2020.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/25/2023]
Abstract
Breast cancer is the most common nonskin cancer in women and the second leading cause of cancer death for women in the United States. Mammography screening is proven to significantly decrease breast cancer mortality, with a 40% or more reduction expected with annual use starting at age 40 for women of average risk. However, less than half of all eligible women have a mammogram annually. The elimination of cost sharing for screening made possible by the Affordable Care Act (2010) encouraged screening but mainly for those already insured. The United States Preventive Services Task Force 2009 guidelines recommended against screening those 40 to 49 years old and have left women over 74 years of age vulnerable to coverage loss. Other populations for whom significant gaps in risk information or screening use exist, including women of lower socioeconomic status, black women, men at higher than average risk of breast cancer, and sexual and gender minorities. Further work is needed to achieve higher rates of screening acceptance for all appropriate individuals so that the full mortality and treatment benefits of mammography screening can be realized.
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Affiliation(s)
- Debra L Monticciolo
- Vice Chair for Research, and Section Chief, Breast Imaging, Department of Radiology, Texas A&M University, Temple, Texas; Baylor Scott & White Healthcare-Central Texas, Temple, Texas.
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11
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Chung HL, Parikh JR. Telemammography: Technical Advances Improve Patient Access in Breast Care. JOURNAL OF BREAST IMAGING 2020; 2:152-156. [PMID: 38424884 DOI: 10.1093/jbi/wbz088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Indexed: 03/02/2024]
Abstract
Screening mammography's efficacy in reducing breast cancer deaths depends on patient compliance with screening recommendations and the radiologist's interpretative skills. Reasons for suboptimal screening compliance may be multifactorial, including possible limitations in access. Additionally, while studies show experienced breast radiologists are more accurate in their mammographic interpretation, only a minority of the nation's mammograms are interpreted by breast imaging specialists. To simultaneously optimize the benefit of early breast cancer detection while minimizing the harms associated with a false positive interpretation, delivery models that help improve access to breast expertise should be considered. Telemammography is one such delivery model that may be underutilized in current practice. While radiologists and other stakeholders of healthcare have accepted teleradiology interpretation of non-mammography studies as routine, telemammography use and acceptance is less well known. In this article, we review the operational components of a telemammography practice in today's information- and technology-dependent society. Current use of telemammography and remaining potential challenges are discussed. Telemammography can improve healthcare delivery and access by bringing together patients and breast expertise. If accepted, use of telemammography can help meet Centers for Disease Control's Healthy People 2020 goals related to breast cancer.
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Affiliation(s)
- Hannah L Chung
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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12
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Mapping mammography in Arkansas: Locating areas with poor spatial access to breast cancer screening using optimization models and geographic information systems. J Clin Transl Sci 2020; 4:437-442. [PMID: 33244433 PMCID: PMC7681135 DOI: 10.1017/cts.2020.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Arkansans have some of the worst breast cancer mortality to incidence ratios in the United States (5th for Blacks, 4th for Whites, 7th overall). Screening mammography allows for early detection and significant reductions in mortality, yet not all women have access to these life-saving services. Utilization in Arkansas is well below the national average, and the number of FDA-approved screening facilities has decreased by 38% since 2001. Spatial accessibility plays an important role in whether women receive screenings. Methods: We use constrained optimization models within a geographic information system (GIS) to probabilistically allocate women to nearby screening facilities, accounting for facility capacity and patient travel time. We examine accessibility results by rurality derived from rural–urban commuting area (RUCA) codes. Results: Under most models, screening capacity is insufficient to meet theoretical demand given travel constraints. Approximately 80% of Arkansan women live within 30 minutes of a screening facility, most of which are located in urban and suburban areas. The majority of unallocated demand was in Small towns and Rural areas. Conclusions: Geographic disparities in screening mammography accessibility exist across Arkansas, but women living in Rural areas have particularly poor spatial access. Mobile mammography clinics can remove patient travel time constraints to help meet rural demand. More broadly, optimization models and GIS can be applied to many studies of healthcare accessibility in rural populations.
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Kim E, Moy L, Gao Y, Hartwell CA, Babb JS, Heller SL. City Patterns of Screening Mammography Uptake and Disparity across the United States. Radiology 2019; 293:151-157. [PMID: 31429681 DOI: 10.1148/radiol.2019190647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric Kim
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - C. Austen Hartwell
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - James S. Babb
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
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14
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Tran L, Tran P. US urban-rural disparities in breast cancer-screening practices at the national, regional, and state level, 2012-2016. Cancer Causes Control 2019; 30:1045-1055. [PMID: 31428890 DOI: 10.1007/s10552-019-01217-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels. METHODS We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor. RESULTS At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%). CONCLUSIONS While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.
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Affiliation(s)
- Lam Tran
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA
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The Breast Radiologist as a Public Educator: Designing an Effective Presentation for a Lay Audience. J Am Coll Radiol 2019; 16:350-354. [DOI: 10.1016/j.jacr.2018.09.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/30/2018] [Indexed: 11/22/2022]
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