title: Is Availability of Mammography Services at Federally Qualified Health Centers Associated with Breast Cancer Mortality-to-Incidence Ratios? An Ecological Analysis.
abstract: OBJECTIVE
  Mammography is the most effective method to detect breast cancer in its earliest stages, reducing the risk of breast cancer death. We investigated the relationship between accessibility of mammography services at Federally Qualified Health Centers (FQHCs) and mortality-to-incidence ratio (MIR) of breast cancer in each county in the United States.
  
  
  METHODS
  County-level breast cancer mortality and incidence rates in 2006-2010 were used to estimate MIRs. We compared breast cancer MIRs based on the density and availability of FQHC delivery sites with or without mammography services both in the county and in the neighboring counties.
  
  
  RESULTS
  The relationship between breast cancer MIRs and access to mammography services at FQHCs differed by race and county of residence. Breast cancer MIRs were lower in counties with mammography facilities or FQHC delivery sites than in counties without a mammography facility or FQHC delivery site. This trend was stronger in urban counties (p=0.01) and among whites (p=0.008). Counties with a high density of mammography facilities had lower breast cancer MIRs than other counties, specifically in urban counties (p=0.01) and among whites (p=0.01). Breast cancer MIR for blacks was the lowest in counties having mammography facilities; and was highest in counties without a mammography facility within the county or the neighboring counties (p=0.03).
  
  
  CONCLUSIONS
  Mammography services provided at FQHCs may have a positive impact on breast cancer MIRs. Expansion of services provided at the FQHCs and placement of FQHCs in additional underserved areas might help to reduce cancer disparities in the United States.
authors.affiliation: 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.|2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.|3 College of Nursing, University of South Carolina , Columbia, South Carolina.
authors.forename: Swann Arp
authors.initials: SA
authors.lastname: Adams
authors.affiliation: 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.|4 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
authors.forename: Seul Ki
authors.initials: SK
authors.lastname: Choi
authors.affiliation: 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.|2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.|4 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Friedman
authors.affiliation: 5 Division of General Internal Medicine, University of Washington , Seattle, Washington.
authors.forename: Mei Po
authors.initials: MP
authors.lastname: Yip
authors.affiliation: 6 Center for Community Based Research, Dana-Farber Cancer Institute , Boston, Massachusetts.|7 Department of Social and Behavioral Sciences, Harvard School of Public Health , Boston, Massachusetts.
authors.forename: Reginald D
authors.initials: RD
authors.lastname: Tucker-Seeley
authors.affiliation: 8 Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
authors.forename: Lisa T
authors.initials: LT
authors.lastname: Wigfall
authors.affiliation: 1 Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.|2 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina.
authors.forename: James R
authors.initials: JR
authors.lastname: Hébert
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008327:Mammography; D008507:Medically Underserved Area; D011314:Preventive Health Services / Q000458:organization & administration*; D012111:Residence Characteristics; D012424:Rural Population; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data