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Disparities in Mammography Screening in the Rural South
Breast Cancer Disparities
Access to mammography screening facilities is essential to ensuring regular screening, which identifies many breast cancers at an early stage when treatment is curative. Two recent reports suggest that access to screening facilities is adequate, but our preliminary study in Texas showed that poor access in rural areas was associated with low screening rates and a high proportion of breast cancers diagnosed at an advanced stage. Based on the large racial/ethnic minorities in these counties, we hypothesized that poor access to screening accounts for some the disparate burden of breast cancer among minority women. But we were unable to examine this issue because there were too few rural minority women with cancer in a single state. Thus, we have secured the cooperation of 13 state cancer registries in the South to ensure an adequate sample. We will link data about mammography facility locations to census, screening, and cancer case data at the county level. We will then examine the associations between presence of an in-county mammography facility and screening rates in women over age 40 and rates of non-invasive and advanced (Stage IV) breast cancer. We will use areal data models to examine spatial patterns of screening and cancer incidence, measured as age-standardized incidence rates. A Poisson lognormal model will be used in cases where observed or expected screening or incidence rates are close to 0. Analyses will compare rural and urban counties and racial and ethnic minorities. Using these methods we also will examine the magnitude of the impact of lack of access to a screening facility on screening and advanced cancer rates as well as the degree to which lack of access accounts for racial/ethnic disparities in rates. If our preliminary results are confirmed, we will be able to target counties for placement of mammography facilities to reduce this disparity.
Regular mammography screening is essential to identifying breast cancers at an early stage when treatment is most likely to be curative. Access to mammography facilities is the first step to universal screening. Our preliminary analysis of access to facilities in Texas showed that half of the counties had no facility, screening rates in counties without facilities were very low, and women in these counties who developed breast cancers were more likely to be diagnosed at an advanced stage. Most counties without facilities had large minority populations and were rural. We reasoned that poor access to screening facilities would account for some of the disparity in later stage of diagnosis among rural minority women. But the number of breast cancers among rural minority women in one state is too small to examine this issue. We will partner with the state cancer registries in 13 states in the South to examine access to screening mammography and its impact on screening rates and the stage of breast cancer at diagnosis. We will focus particular attention on rural minority populations because they are disadvantaged by rural residence as well as low education, high poverty, and lack of healthcare insurance.