Access to mammography facilities and detection of breast cancer by screening mammography: A GIS approach

Objectives: The objective of the study was to examine theassociation between access to mammography facilities and utilization ofscreening mammography in an urban population.Methods: Data on female breast cancer cases were obtained from anextensive mammography surveillance project. Distance to mammographyfacilities was measured by using GIS, which was followed by measuringgeographical access to mammography facilities using Floating CatchmentArea (FCA) Method (considering all available facilities within anarbitrary radius from the woman's residence by using Arc GIS 9.0software).Results: Of 2,024 women, 91.4% were Caucasian; age ranged from25 to 98 years; most (95%) were non-Hispanic in origin. Logisticregression found age, family history, hormone replacement therapy,physician recommendation, and breast cancer stage at diagnosis to besignificant predictors of having had a previous mammogram. Womenhaving higher access to mammography facilities were less likely to havehad a previous mammogram compared to women who had low access,considering all the facilities within 10 miles (OR=0.41, CI=0.22-0.76), 30miles (OR=0.52, CI=0.29-0.91) and 40 miles (OR=0.51, CI=0.28-0.92)radiuses. Conclusions: Physical distance to mammography facilities doesnot necessarily predict utilization of mammogram and greater access doesnot assure greater utilizations, due to constraints imposed by socioeconomic and cultural barriers. Future studies should focus on measuringaccess to mammography facilities capturing a broader dimension ofaccess considering qualitative aspect of facilities, as well as other travelimpedances.