Living near mammography unit may improve outcomes

NEW YORK (Reuters Health) - Women who live in counties with a mammography facility are three times as likely to have received the test in the past two years than women in counties without these facilities, new research in the American Journal of Preventive Medicine shows.

These women were also 64% less likely to be diagnosed with late-stage breast cancer than women who didn't have a mammography facility nearby, Dr. Linda S. Elting of The University of Texas M.D. Anderson Cancer Center in Houston and her colleagues found.

Early breast cancer diagnosis is key to surviving the disease, Elting noted in an interview; fewer than 30% of women diagnosed with advanced cancer will survive for five years. "It's still for most women an ultimately fatal disease if it's diagnosed at a late stage," she said.

Regular mammographies are recommended for women over 40, although their usefulness for women younger than 50 and older than 75 "is the subject of ongoing debate," Elting and her team note in the American Journal of Preventive Medicine.

While the US government has studied accessibility to mammography across the country and found it to be generally "adequate," the researchers say, there is little information on access in rural areas. "In Texas if there's no mammography facility in your county, you may be 100 or more miles away from a facility," Elting said. "That makes a big difference if you're poor, if you're unable to get off from work for a whole day."

The researchers hypothesized that women living in counties with a mammography facility would be more likely to get screened, and less likely to be diagnosed with late-stage breast cancer. To investigate, they looked at data for all 254 of Texas's counties and data on a representative group of 2,418 women over 40 who responded to a 2004 telephone survey.

Half of the counties had no mammography facility in 2002-2004. The populations of these counties were poorer, less likely to be insured, less likely to speak English and less likely to have graduated from high school.

The researcher found that 68 percent of women in counties with facilities reported having mammograms in the last two years, compared to 39 percent of those whose counties did not have such facilities. Even after the researchers accounted for socioeconomic differences and other relevant factors, they found that women living in counties with mammography facilities were more than three times more likely to have had a mammogram.

Overall, one in 372 of the women in the study were diagnosed with breast cancer during 2004. Women residing in counties with breast cancer screening facilities were 64% less likely to be diagnosed with advanced disease.

Elting and her colleagues have received funding from the Susan G. Komen for the Cure foundation to conduct the same investigation in 14 Southern states.

"If this is confirmed in studies of other states, the provision of mammography services in every county should be implemented," the researchers write. "Mobile mammography may provide a practical means of building capacity in rural areas."

Another important aspect is finding cost-effective ways for cash-strapped states to help rural women get mammograms, Elting noted. She and her colleagues plan to study whether mobile mammography could be one such approach.

SOURCE: American Journal of Preventive Medicine, August 2009.