title: Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related?
abstract: OBJECTIVE
  Mammography, unlike MRI, is relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies on the basis of sociodemographic or breast cancer risk factors is unknown.
  
  
  METHODS
  The investigators examined screening mammography and MRI between 2005 and 2012 in the Breast Cancer Surveillance Consortium by (1) travel time to the closest and actual mammography facility used and the difference between the two, (2) women's breast cancer risk factors, and (3) sociodemographic characteristics. Logistic regression was used to examine the odds of traveling farther than the closest facility in relation to women's characteristics.
  
  
  RESULTS
  Among 821,683 screening mammographic examinations, 76.6% occurred at the closest facility, compared with 51.9% of screening MRI studies (n = 3,687). The median differential travel time among women not using the closest facility for mammography was 14 min (interquartile range, 8-25 min) versus 20 min (interquartile range, 11-40 min) for breast MRI. Differential travel time for both imaging modalities did not vary notably by breast cancer risk factors but was significantly longer for nonurban residents. For non-Hispanic black compared with non-Hispanic white women, the adjusted odds of traveling farther than the closest facility were 9% lower for mammography (odds ratio, 0.91; 95% confidence interval, 0.87-0.95) but more than two times higher for MRI (odds ratio, 2.64; 95% confidence interval, 1.36-5.13).
  
  
  CONCLUSIONS
  Breast cancer risk factors were not related to excess travel time for screening MRI, but sociodemographic factors were, suggesting the possibility that geographic distribution of advanced imaging may exacerbated disparities for some vulnerable populations.
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Epidemiology, 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: Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington; Fred Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.affiliation: Group Health Research Institute, Seattle, Washington; Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington.
authors.forename: David
authors.initials: D
authors.lastname: Benkeser
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Epidemiology, 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: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Epidemiology, 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
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Hill
authors.affiliation: The Geography Department, Dartmouth College, Hanover, New Hampshire.
authors.forename: Xun
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008327:Mammography; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014195:Travel; D014481:United States
keywords: Breast imaging; GIS; Geographic Information Systems; MRI; proximity to care; travel time