healthcare access Archives - The Imaging Wire

It’s no secret that there are sharp regional differences in healthcare access in the U.S. But a new report puts a price on the access problem as it pertains to mammography – nearly 10k additional cases of breast cancer a year due to limited access in “cancer screening deserts” that don’t have mammography equipment.

Mammography has been a success story among population-based cancer screening tests.

The widespread implementation of breast screening in the 1980s is generally credited – along with improved treatments – with reducing breast cancer mortality by 44% from 1982 to 2022.

But breast cancer is still a lethal disease, killing 42k women a year in the U.S.

And screening’s benefits have not been distributed equally, with women in rural areas and those with lower socioeconomic status having lower completion rates.

What would it take to even out the differences? To answer this question, researchers from the Milken Institute analyzed the U.S. mammography installed base at the county level.

They then correlated machine distribution with county population as well as cancer detection rates to find out how efficiently different counties were performing.

They discovered…

High regional variation in mammography machine distribution.
The lowest distribution was in the Southwest and southern Midwest while the highest was in major urban areas, particularly on the coasts.
890 counties did not have mammography machines.
Counties with the most mammography machines had 7.5% higher breast cancer incidence rates per 100k women compared to counties with no machines (329 vs. 306) – a sign they were detecting more cancers.
There were 155 counties where mammography machine deployment would have the biggest return.
And 9.6k breast cancer cases would be detected if counties with low or no mammography capacity detected breast cancer at the same rate as high-detection counties.

The new results track with another recent study that also revealed the presence of cancer screening deserts in the Southwest.

So what can be done? The Milken researchers proposed that low-resource counties be targeted for investment, but simply installing new machines won’t by itself cure the access problem.

It’s also important to address barriers such as language, transportation, and cost-sharing in order to achieve equal access.

The Takeaway

The new report shows that mammography access isn’t just an abstract issue – it’s one that is claiming the lives of thousands of U.S. women a year. Fortunately, the Milken researchers have done much of the legwork in identifying the specific areas that deserve attention.

Despite the proven value of breast screening, compliance rates still aren’t as high as they should be. A new study in Clinical Breast Cancer shows how mobile mammography can improve screening adherence – especially among groups traditionally underserved in the healthcare system.

Estimates of mammography compliance vary – the American Cancer Society estimates that the overall U.S. breast screening rate held steady at 64-66% from 2000 to 2018.

But a variety of factors can influence screening rates, from race to income to location.

Mobile mammography is an obvious solution that brings the imaging test to women rather than requiring them to travel.

But some questions have persisted about mobile screening, such as whether it might cannibalize facility-based mammography programs, which have higher fixed costs.

In the new study, researchers from the Harvey L. Neiman Health Policy Institute reviewed CMS claims data for 2.6M eligible women from 2004 to 2021.

Researchers found …

50% of women had received a screening mammogram.
Only 0.4% used mobile mammography, but rates were higher in rural areas (1%) compared to large cities (0.3%) and small towns (0.4%).
American Indian or Alaska Native race was the factor most predictive for receiving mobile mammography (OR=5.5).
Other predictive factors included residence in a rural geography (OR=3.3), as well as in a community with lower income (OR=1.4).
Mobile mammography did not cannibalize facility-based mammography, based on data from heat maps showing utilization of both types of service.

Researchers concluded that mobile mammography can reduce health disparities by bringing imaging technology to underserved communities that might not otherwise have access to it.

The findings echo a study earlier this year in which mobile mammography was also found to benefit the environment by reducing greenhouse gas emissions that occur when patients have to travel to medical facilities for screening.

The Takeaway

It may seem like a no-brainer to bring imaging to the people who need it, but the new study provides valuable evidence that the practice works on a national scale. Increased use of mobile imaging is an important tool for addressing persistent disparities in access to care.

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