title: Geographic Access to Mammography and Its Relationship to Breast Cancer Screening and Stage at Diagnosis: A Systematic Review.
abstract: BACKGROUND
  A review was conducted to summarize the current evidence and gaps in the literature on geographic access to mammography and its relationship to breast cancer-related outcomes.
  
  
  METHODS
  Ovid, Medline, and PubMed were searched for articles published between January 1, 2000, and April 1, 2013, using Medical Subject Headings and key terms representing geographic accessibility and breast cancer-related outcomes. Owing to a paucity of breast cancer treatment and mortality outcomes meeting the criteria (N = 6), outcomes were restricted to breast cancer screening and stage at diagnosis. Studies included one or more of the following types of geographic accessibility measures: capacity, density, distance, and travel time. Study findings were grouped by outcome and type of geographic measure.
  
  
  RESULTS
  Twenty-one articles met the inclusion criteria. Fourteen articles included stage at diagnosis as an outcome, five included mammography use, and two included both. Geographic measures of mammography accessibility varied widely across studies. Findings also varied, but most articles found either increased geographic access to mammography associated with increased use and decreased late-stage at diagnosis or no association.
  
  
  CONCLUSIONS
  The gaps and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between geographic mammography access and breast cancer-related outcomes. Future studies should focus on the development and application of more precise and consistent measures of geographic access to mammography.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois. Electronic address: jkhan4@uic.edu.
authors.forename: Jenna A
authors.initials: JA
authors.lastname: Khan-Gates
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ersek
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; College of Nursing, University of South Carolina, Columbia, South Carolina.
authors.forename: Swann A
authors.initials: SA
authors.lastname: Adams
authors.affiliation: Department of Clinical Science, Southwestern University, Dallas, Texas.
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D062305:Geographic Mapping; D006297:Health Services Accessibility; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D012111:Residence Characteristics; D013997:Time Factors