title: Geographic access to breast imaging for US women.
abstract: OBJECTIVE
  The breast imaging modalities of mammography, ultrasound, and MRI are widely used for screening, diagnosis, treatment, and surveillance of breast cancer. Geographic access to breast imaging services in various modalities is not known at a national level overall or for population subgroups.
  
  
  METHODS
  A retrospective study of 2004-2008 Medicare claims data was conducted to identify ZIP codes in which breast imaging occurred, and data were mapped. Estimated travel times were made for each modality for 215,798 census block groups in the contiguous United States. Using Census 2010 data, travel times were characterized by sociodemographic factors for 92,788,909 women aged ≥30 years, overall, and by subgroups of age, race/ethnicity, rurality, education, and median income.
  
  
  RESULTS
  Overall, 85% of women had travel times of ≤20 minutes to nearest mammography or ultrasound services, and 70% had travel times of ≤20 minutes for MRI with little variation by age. Native American women had median travel times 2-3 times longer for all 3 modalities, compared to women of other racial/ethnic groups. For rural women, median travel times to breast imaging services were 4-8-fold longer than they were for urban women. Black and Asian women had the shortest median travel times to services for all 3 modalities.
  
  
  CONCLUSIONS
  Travel times to mammography and ultrasound breast imaging facilities are short for most women, but for breast MRI, travel times are notably longer. Native American and rural women are disadvantaged in geographic access based on travel times to breast imaging services. This work informs potential interventions to reduce inequities in access and utilization.
authors.affiliation: Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Electronic address: Tracy.L.Onega@dartmouth.edu.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hubbard
authors.affiliation: University of New Mexico, Albuquerque, New Mexico.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Hill
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachussetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Carlos
authors.affiliation: Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alford-Teaster
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Andy
authors.initials: A
authors.lastname: Bogart
authors.affiliation: Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: DeMartini
authors.affiliation: Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.affiliation: Department of Radiology, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Louise
authors.initials: L
authors.lastname: Henderson
authors.affiliation: Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
mesh_terms: D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000175:diagnosis* / Q000208:ethnology; D019352:Censuses; D003710:Demography; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D014195:Travel; D016217:Ultrasonography, Mammary; D014481:United States
keywords: Travel time; access; breast imaging; disparities; mammography