Does distance matter? Distance to mammography facilities and stage at diagnosis of breast cancer in Kentucky.
BACKGROUND
National and regional data indicate that breast cancer early detection is low in Kentucky, especially rural regions, perhaps because access to mammography services can be problematic.


OBJECTIVE
This study examined the distance between residences of women diagnosed with breast cancer and the nearest mammography facility, as a risk factor for advanced stage diagnosis in rural populations.


METHODS
1999-2003 Kentucky Cancer Registry data were used for this study. A total of 12,322 women, aged 40 and older at diagnosis, with no previous history of cancer, and with known cancer stage were included. Travel distance was obtained using a geographic information system (GIS). Hierarchical logistic regression models were used to analyze the relationship between travel distance and advanced stage diagnosis.


RESULTS
Advanced diagnoses had longer average travel distances than early stage diagnoses (P < 0.01). After adjusting for age, race, insurance, and education at census tract level, the odds of advanced diagnosis were significantly greater for women residing over 15 miles from a facility, compared to those living within 5 miles (adjusted OR = 1.50, 95% CI = 1.25-1.80).


CONCLUSIONS
Although socioeconomic status, race, and age may help explain advanced diagnoses, longer travel distance also adversely affects early detection for rural populations. Accurate measurement of spatial accessibility indicators, such as travel distance, facilitates identification of at-risk groups so that interventions can be developed to reduce this disease.
Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA.
Bin
B
Huang
Mark
M
Dignan
Daikwon
D
Han
Owen
O
Johnson
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007348:Insurance, Health; D007629:Kentucky / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D044469:Racial Groups; D012042:Registries; D012189:Retrospective Studies; D014195:Travel / Q000706:statistics & numerical data*