The Role of Geography in Low Mammography Screening Rates and Late-Stage Breast Cancer Diagnosis in Utah

Abstract

Abstract Purpose: Mammography screening rates in Utah have been lower than other states for nearly 20 years. We examine the role of geographic factors on mammography screening rates and late-stage breast cancer diagnosis in Utah. Methods: Mammography screening data from the 2008 and 2010 Utah Behavioral Risk Factor Surveillance System included Utah women aged 40–74 (weighted N = 417,064). Utah Cancer Registry data included women 40+ years, who were diagnosed with breast cancer from 2004–2008 (N = 6,500). Multilevel logistic regression was used to examine the association between measures of geographic access to mammography (travel time, geo access scores, rural/urban residence) and individual factors (age, race/ethnicity, insurance) and the odds of (a) not having a mammogram within the last two years and (b) being diagnosed with late stage breast cancer. Geo access scores are composite values based on the number of mammography facilities and the distribution of drive times. Results: Overall 32.7% (95%CI 31.1%–34.5%) of Utah women 40–74 reported not having a mammogram within the last 2 years and 31.3% of women aged 40+ were diagnosed with late-stage breast cancer. A disproportionate number 43.1% (95%CI 39.9%–46.3%) of women 40–49 did not have a mammogram within the last 2 years compared to women 50–74 (26.8% 95%CI 24.9%–28.7%). Geographic access measures were not associated with mammography screening and late-stage breast cancer diagnosis among women 40–74. Travel time was moderately significant for women living >20 minutes from a mammography facility compared to women living <5 min (OR = 1.23 95%CI 1.01–1.50), even after controlling for age, race/ethnicity, and insurance status. Women aged 50+ with low geo access scores had higher odds (OR = 1.20 95%CI 1.04 1.37) of late-stage breast cancer diagnosis compared to women with high geo access scores. Conclusion: Geographic access may be a risk factor for late-stage breast cancer for specific segments of the population, who may benefit from targeted interventions to improve early detection. Future work should consider alternate geographic access measures and other potential sociodemographic or cultural barriers to screening in Utah.