Abstract
Access to healthcare is essential in the pursuit of universal health coverage. Components of access are availability, accessibility (spatial and non-spatial), affordability and acceptability. Measuring spatial accessibility is common approach to evaluating access to health care. This study aimed to determine the availability and spatial accessibility of subsidised mammogram screening in Peninsular Malaysia. Availability was determined from the number and distribution of facilities. Spatial accessibility was determined using the travel impedance approach to represent the revealed access as opposed to potential access measured by other spatial measurement methods. The driving distance of return trips from the respondent’s residence to the facilities was determined using a mapping application. The travel expenditure was estimated by multiplying the total travel distance by a standardised travel allowance rate, plus parking fees. Respondents in this study were 344 breast cancer patients who received treatment at 4 referral hospitals between 2015 and 2016. In terms of availability, there were at least 6 major entities which provided subsidised mammogram programs. Facilities with mammogram involved with these programs were located more densely in the central and west coast region of the Peninsula. The ratio of mammogram facility to the target population of women aged 40–74 years ranged between 1: 10,000 and 1:80,000. In terms of accessibility, of the 3.6% of the respondents had undergone mammogram screening, their mean travel distance was 53.4 km (SD = 34.5, range 8–112 km) and the mean travel expenditure was RM 38.97 (SD = 24.00, range RM7.60–78.40). Among those who did not go for mammogram screening, the estimated travel distance and expenditure had a skewed distribution with median travel distance of 22.0 km (IQR 12.0, 42.0, range 2.0–340.0) and the median travel cost of RM 17.40 (IQR 10.40, 30.00, range 3.40–240.00). Higher travel impedance was noted among those who lived in sub-urban and rural areas. In summary, availability of mammogram facilities was good in the central and west coast of the peninsula. The overall provider-to-population ratio was lower than recommended. Based on the travel impedance approach used, accessibility to subsidised mammogram screening among the respondents was good in urban areas but deprived in other areas. This study was a preliminary study with limitations. Nonetheless, the evidence suggests that actions have to be taken to improve the accessibility to opportunistic mammogram screening in Malaysia in pursuit of universal health coverage.
Highlights
Diagnosis of breast cancer by mammography screening has become a critical way to reduce mortality [1]
In this study the Peninsula Malaysia was divided into several regions: central and west coast region (Kuala Lumpur, Selangor, Negeri Sembilan), southern region (Melaka and Johor), northern region (Perak, Kedah, Pulau Pinang (Penang), Perlis) and eastern region (Pahang, Terengganu and Kelantan)
The National Cancer Council Malaysia (NCCM) provide free mammogram services using one mobile mammogram machine housed in a 40-feet mobile trailer
Summary
Diagnosis of breast cancer by mammography screening has become a critical way to reduce mortality [1]. Breast cancer survival drops dramatically for late stage diagnoses [2]. In the randomized controlled trials for women aged 40 to 74 years, screening with mammography has been associated with a 15% to 20% relative reduction in mortality from breast cancer [3]. A prospective cohort study in Norway found that invitation to modern mammography screening may reduce deaths from breast cancer by about 28% [4]. Women without adequate accessibility to timely mammography screening are more likely to develop late-stage breast cancer [5]. A study showed that advanced diagnoses had longer average travel distances than early stage diagnoses. After adjusting for age, race, insurance and education, the odds of advanced diagnosis were significantly greater for women residing over 15 miles from a facility, compared to those living within 5 miles [6]
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