Adedayo A Onitilo1, Hong Liang2, Rachel V Stankowski3, Jessica M Engel4, Michael Broton5, Suhail A Doi6, Douglas A Miskowiak7. 1. Hematology, Weston Center, Marshfield Clinic, Weston, Wisconsin, USA. onitilo.adedayo@marshfieldclinic.org. 2. Research Foundation, Marshfield Clinic, Weston, Wisconsin, USA. liang.hong@mcrf.mfldclin.edu. 3. Research Foundation, Marshfield Clinic, Weston, Wisconsin, USA. stankowski.rachel@mcrf.mfldclin.edu. 4. Cancer Care at St. Michael's, Marshfield Clinic, Stevens Point, Wisconsin, USA. engel.jessica@marshfieldclinic.org. 5. Department of Geography/Geology, UW, Stevens Point, Wisconsin, USA. mbroton@uwsp.edu. 6. Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, Queensland, Australia. s.doi@sph.uq.edu.au. 7. Department of Geography/Geology, UW, Stevens Point, Wisconsin, USA. miskowi@uwsp.edu.
Abstract
INTRODUCTION: Routine mammography screening and early detection are important prognostic indicators for breast cancer. Geographical and seasonal barriers to mammography services and relationship to breast cancer stage at diagnosis were examined. METHODS: Travel time to mammography center, seasonal distribution of mammogram use, mammography frequency, and stage of cancer were retrospectively examined in 1428 female patients diagnosed with primary breast cancer at a tertiary care clinic system in Wisconsin, USA, from 2002 to 2008. RESULTS: Women with no missed mammograms before diagnosis lived a median of 15 minutes from the nearest facility, while those who missed five of their past five annual mammograms lived nearly twice as far, with a median travel time of 27 minutes (p<0.0001). There was a direct relationship between travel time to nearest mammogram facility and stage of breast cancer at diagnosis, with travel time increasing from 17 to 24 minutes for stage 0 and stage 4 breast cancers, respectively (p=0.0586). Women were less likely to undergo mammography screening during the winter months (p<0.0001), especially women with greater than 30 mi (48.3 km) to travel to the nearest mammogram facility (p=0.0448). CONCLUSIONS: In the studied service area, travel time to nearest mammogram center appears inversely related to regular mammography screening and breast cancer stage at diagnosis. Mammograms are less common in the winter, especially in women with further to travel. This is the first study to demonstrate that inclement winter weather may impact on screening behaviors in rural areas and demonstrates the importance of considering climate as part of geographical access to preventative care.
INTRODUCTION: Routine mammography screening and early detection are important prognostic indicators for breast cancer. Geographical and seasonal barriers to mammography services and relationship to breast cancer stage at diagnosis were examined. METHODS: Travel time to mammography center, seasonal distribution of mammogram use, mammography frequency, and stage of cancer were retrospectively examined in 1428 female patients diagnosed with primary breast cancer at a tertiary care clinic system in Wisconsin, USA, from 2002 to 2008. RESULTS:Women with no missed mammograms before diagnosis lived a median of 15 minutes from the nearest facility, while those who missed five of their past five annual mammograms lived nearly twice as far, with a median travel time of 27 minutes (p<0.0001). There was a direct relationship between travel time to nearest mammogram facility and stage of breast cancer at diagnosis, with travel time increasing from 17 to 24 minutes for stage 0 and stage 4 breast cancers, respectively (p=0.0586). Women were less likely to undergo mammography screening during the winter months (p<0.0001), especially women with greater than 30 mi (48.3 km) to travel to the nearest mammogram facility (p=0.0448). CONCLUSIONS: In the studied service area, travel time to nearest mammogram center appears inversely related to regular mammography screening and breast cancer stage at diagnosis. Mammograms are less common in the winter, especially in women with further to travel. This is the first study to demonstrate that inclement winter weather may impact on screening behaviors in rural areas and demonstrates the importance of considering climate as part of geographical access to preventative care.
Authors: Tracy Onega; Christoph I Lee; David Benkeser; Jennifer Alford-Teaster; Jennifer S Haas; Anna N A Tosteson; Deirdre Hill; Xun Shi; Louise M Henderson; Rebecca A Hubbard Journal: J Am Coll Radiol Date: 2016-03-22 Impact factor: 5.532
Authors: Jennifer Alford-Teaster; Jane M Lange; Rebecca A Hubbard; Christoph I Lee; Jennifer S Haas; Xun Shi; Heather A Carlos; Louise Henderson; Deirdre Hill; Anna N A Tosteson; Tracy Onega Journal: Int J Health Geogr Date: 2016-02-18 Impact factor: 3.918
Authors: Zaria Tatalovich; Li Zhu; Alicia Rolin; Denise R Lewis; Linda C Harlan; Deborah M Winn Journal: Int J Health Geogr Date: 2015-10-24 Impact factor: 3.918