abstract: 'Purpose: 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 service''s 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.'
affiliation: 'Onega, T (Corresponding Author), Geisel Sch Med Dartmouth, HB 7927 Rubin
  8, Lebanon, NH 03756 USA.

  Onega, Tracy; Alford-Teaster, Jennifer; Tosteson, Anna N. A., Geisel Sch Med Dartmouth,
  Dept Community \& Family Med, Lebanon, NH 03756 USA.

  Onega, Tracy; Carlos, Heather A.; Alford-Teaster, Jennifer; Tosteson, Anna N. A.,
  Geisel Sch Med Dartmouth, Norris Cotton Canc Ctr, Lebanon, NH 03756 USA.

  Onega, Tracy; Tosteson, Anna N. A., Geisel Sch Med Dartmouth, Dartmouth Inst Hlth
  Policy \& Clin Practice, Lebanon, NH 03756 USA.

  Hubbard, Rebecca; Bogart, Andy; Buist, Diana S. M., Grp Hlth Res Inst, Seattle,
  WA USA.

  Hill, Deirdre, Univ New Mexico, Albuquerque, NM 87131 USA.

  Lee, Christoph I., Univ Washington, Sch Med, Dept Radiol, Seattle, WA 98195 USA.

  Lee, Christoph I., Univ Washington, Sch Med, Dept Hlth Serv, Seattle, WA USA.

  Haas, Jennifer S., Brigham \& Womens Hosp, Div Gen Internal Med, Boston, MA 02115
  USA.

  DeMartini, Wendy B., Univ Wisconsin, Dept Radiol, Sch Med \& Publ Hlth, Madison,
  WI 53706 USA.

  Kerlikowske, Karla, Univ Calif San Francisco, Dept Med, San Francisco, CA USA.

  Kerlikowske, Karla, Univ Calif San Francisco, Dept Epidemiol \& Biostat, San Francisco,
  CA 94143 USA.

  Virnig, Beth A., Univ Minnesota, Sch Publ Hlth, Minneapolis, MN USA.

  Henderson, Louise, Univ N Carolina, Dept Radiol, Chapel Hill, NC USA.'
author: Onega, Tracy and Hubbard, Rebecca and Hill, Deirdre and Lee, Christoph I.
  and Haas, Jennifer S. and Carlos, Heather A. and Alford-Teaster, Jennifer and Bogart,
  Andy and DeMartini, Wendy B. and Kerlikowske, Karla and Virnig, Beth A. and Buist,
  Diana S. M. and Henderson, Louise and Tosteson, Anna N. A.
author-email: Tracy.L.Onega@dartmouth.edu
author_list:
- family: Onega
  given: Tracy
- family: Hubbard
  given: Rebecca
- family: Hill
  given: Deirdre
- family: Lee
  given: Christoph I.
- family: Haas
  given: Jennifer S.
- family: Carlos
  given: Heather A.
- family: Alford-Teaster
  given: Jennifer
- family: Bogart
  given: Andy
- family: DeMartini
  given: Wendy B.
- family: Kerlikowske
  given: Karla
- family: Virnig
  given: Beth A.
- family: Buist
  given: Diana S. M.
- family: Henderson
  given: Louise
- family: Tosteson
  given: Anna N. A.
da: '2023-09-28'
doi: 10.1016/j.jacr.2014.03.022
files: []
issn: 1546-1440
journal: JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY
keywords: Travel time; access; mammography; breast imaging; disparities
keywords-plus: 'CANCER STAGE; TRAVEL-TIME; MEDICARE BENEFICIARIES; HEALTH-CARE;

  DIAGNOSIS; MAMMOGRAPHY; PET; SURVEILLANCE; DISPARITIES; COVERAGE'
language: English
month: SEP
number: '9'
number-of-cited-references: '38'
orcid-numbers: 'Hubbard, Rebecca/0000-0003-0879-0994

  Lee, Christoph/0000-0002-8185-7721

  HAAS, JENNIFER/0000-0001-7227-851X'
pages: 874-882
papis_id: 9da68bcf3228f1921223b43181cb6120
ref: Onega2014geographicaccess
researcherid-numbers: 'Hubbard, Rebecca/Y-6500-2019

  '
times-cited: '62'
title: Geographic Access to Breast Imaging for US Women
type: Article
unique-id: WOS:000341541200012
usage-count-last-180-days: '0'
usage-count-since-2013: '18'
volume: '11'
web-of-science-categories: Radiology, Nuclear Medicine \& Medical Imaging
year: '2014'