An assessment of the quality of mammography care at facilities treating medically vulnerable populations.
BACKGROUND
Women in medically vulnerable populations, including racial and ethnic minorities, socioeconomically disadvantaged, and residents of rural areas, experience higher breast cancer mortality than do others. Whether mammography facilities that treat vulnerable women demonstrate lower quality of care than other facilities is unknown.


OBJECTIVE
To assess the quality of mammography women receive at facilities characterized as serving a high proportion of medically vulnerable populations.


METHODS
We prospectively collected self-reported breast cancer risk factor information, mammography interpretations, and cancer outcomes on 1,579,929 screening mammography examinations from 750,857 women, aged 40-80 years, attending any of 151 facilities in the Breast Cancer Surveillance Consortium between 1998 and 2004. To classify facilities as serving medically vulnerable populations, we used 4 criteria: educational attainment, racial/ethnic minority, household income, and rural/urban residence.


RESULTS
After adjustment for patient-level factors known to affect mammography accuracy, facilities serving vulnerable populations had significantly higher mammography specificity than did other facilities: ie, those serving a higher proportion of women who were minorities [odds ratio (OR): 1.32; 95% confidence interval (CI): 1.01-1.73], living in rural areas (1.45; 1.15-1.73), and with lower household income (1.33; 1.05-1.68). We observed no statistically significant differences between facilities in mammography sensitivity.


CONCLUSIONS
Facilities serving high proportions of vulnerable populations provide screening mammography with equal or better quality (as reflected in higher specificity with no corresponding decrease in sensitivity) than other facilities. Further research is needed to understand the mechanisms underlying these findings.
Goldman
L Elizabeth
LE
Department of Medicine, University of California, San Francisco, California 94143, USA. goldman1@medicine.ucsf.edu
Haneuse
Sebastien J-P A
SJ
Miglioretti
Diana L
DL
Kerlikowske
Karla
K
Buist
Diana S M
DS
Yankaskas
Bonnie
B
Smith-Bindman
Rebecca
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D005260:Female; D006268:Health Facilities; D006801:Humans; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries; D015203:Reproducibility of Results; D014481:United States; D035862:Vulnerable Populations