Does Spatial Access to Mammography Have an Effect on Early Stage of Breast Cancer Diagnosis? A county-level Analysis for New York State.

Abstract

Breast cancer is the most common type of women's cancer. New York (NY) State has a slightly higher incidence than that of the United States. On average, 65% of breast cancer patients in NY are diagnosed at an early stage, with county averages ranging from 55% to 75%, indicating regional disparities. In this study we evaluate the relationship between early stage of breast cancer diagnosis and geographic access to mammography in NY. We utilized indicators of spatial autocorrelation to assess if significant clusters of early stage breast cancer diagnosis and mammogram facilities occurred across NY counties over the years 2007-11. We used spatial autoregressive models to evaluate the importance of density and proximity of facilities in early stage cancer, Among 62 counties, the density of mammogram facilities varied from 0.2 to 2 sites/10,000 women, while distance to a facility from population centroid ranged between 0.44 to 38.58 miles. Four significant spatial clusters of high percentages of early stage breast cancer diagnosis were identified. The spatial autoregressive model indicated that the only statistically significant variable relating to higher percent of early stage at diagnosis was higher education (p=0.005). Using the county as the spatial unit of analysis, there were no significant effects of spatial access to mammography on the percent of early stage breast cancer diagnosis.