title: Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations.
abstract: OBJECTIVE
  Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations.
  
  
  METHODS
  73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012.
  
  
  METHODS
  We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women.
  
  
  RESULTS
  Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations.
  
  
  CONCLUSIONS
  Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use.
authors.affiliation: Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109 Dept of Health Services, University of Washington School of Public Health; 825 Eastlake Avenue East, Seattle, WA 98109 stophlee@uw.edu.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.affiliation: Group Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101.
authors.forename: Andy
authors.initials: A
authors.lastname: Bogart
authors.affiliation: Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Germino
authors.affiliation: Dept of Internal Medicine, University of California, San Francisco School of Medicine; 1001 Potrero Ave, Box 1364, San Francisco, CA 94110.
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Goldman
authors.affiliation: Dept of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania; 423 Guardian Drive, Philadelphia, PA 19104.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Dept of Medicine, Harvard Medical School; Dana Farber Harvard Cancer Institute; Dept of Social and Behavioral Sciences, Harvard School of Public Health; 1620 Tremont Street, Boston, MA 02120.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Dept of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico; 1201 Camino de Salud NE, 1 University of New Mexico, Albuquerque, NM, 87102.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Hill
authors.affiliation: Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756.
authors.forename: Anna Na
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Alford-Teaster
authors.affiliation: Dept of Radiology, University of Wisconsin School of Medicine and Public Health; 600 Highland Avenue, Madison WI 53792.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: DeMartini
authors.affiliation: Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109.
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.affiliation: Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Onega
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D005102:Health Expenditures; D006268:Health Facilities / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D061705:Image-Guided Biopsy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008327:Mammography; D008913:Minority Groups; D015999:Multivariate Analysis; D012042:Registries; D012424:Rural Population; D012959:Socioeconomic Factors; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data*; D014481:United States; D035862:Vulnerable Populations
keywords: access; advanced breast imaging; breast cancer; disparities; screening mammography