social determinants of health Archives

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.

A new study published this week in JAMA Network Open indicates that – even when women have access to breast screening – other factors can limit mammography’s life-saving impact. Researchers found that women with more unmet social needs had lower breast screening rates and higher rates of advanced disease – even if they had access to a mammography center.

Research into social determinants of health – the racial, demographic, and environmental factors that can affect the quality of a person’s health – have gained steam in the last several years.

Numerous studies have found that racial and economic differences result in major disparities in healthcare outcomes – and some of the biggest variations occur in screening.

In the new study, researchers noted that unmet social needs can include housing instability, social isolation, food insecurity, and transportation challenges, and these needs can occur even in high-income areas with access to screening mammography.

They studied the issue in Miami-Dade County, Florida, where all women 200% below the poverty line have access to no-cost screening mammography at safety net hospitals – in theory removing cost as a barrier to breast screening.

Researchers studied 336 women who filled out a survey on social needs; of these, 62% self-identified as Hispanic, 19% as Black, and 19% as White, and 76% had screening mammograms. Researchers found a lower odds ratio for getting a mammogram due to …

An increasing number of unmet social needs (OR=0.74)
Increasing age at diagnosis (OR=0.92)

Patients were also more likely to present with late-stage disease if they …

Had two or more unmet social needs (33% vs. 18%)
Had problems with their home utilities (17% vs. 5%) or childcare access (12% vs. 3%)
Were presenting to a safety net hospital (31% vs. 18%)

The authors noted that although no single unmet social need was found to have a statistically significant impact on screening mammography rates, multiple needs piling up could “overwhelm” patients so they can’t find the time to schedule preventive health check-ups.

The Takeaway

The new findings offer a more complex view of breast screening disparities beyond just access to mammograms. Public health authorities and hospitals providing women’s health services may need to offer screening of at-risk patients and a broader range of services in order to make sure that the life-saving benefits of mammography are enjoyed on a wider – and more equitable – scale.

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