Mapping mammography in Arkansas: Locating areas with poor spatial access to breast cancer screening using optimization models and geographic information systems

Abstract

Introduction: Arkansans have some of the worst breast cancer mortality to incidence ratios in the United States (5th for Blacks, 4th for Whites, 7th overall). Screening mammography allows for early detection and significant reductions in mortality, yet not all women have access to these life-saving services. Utilization in Arkansas is well below the national average, and the number of FDA-approved screening facilities has decreased by 38% since 2001. Spatial accessibility plays an important role in whether women receive screenings. Methods: We use constrained optimization models within a geographic information system (GIS) to probabilistically allocate women to nearby screening facilities, accounting for facility capacity and patient travel time. We examine accessibility results by rurality derived from rural–urban commuting area (RUCA) codes. Results: Under most models, screening capacity is insufficient to meet theoretical demand given travel constraints. Approximately 80% of Arkansan women live within 30 minutes of a screening facility, most of which are located in urban and suburban areas. The majority of unallocated demand was in Small towns and Rural areas. Conclusions: Geographic disparities in screening mammography accessibility exist across Arkansas, but women living in Rural areas have particularly poor spatial access. Mobile mammography clinics can remove patient travel time constraints to help meet rural demand. More broadly, optimization models and GIS can be applied to many studies of healthcare accessibility in rural populations.

A Catchment and Location-Allocation Analysis of Mammography Access in Delaware, US: Implications for disparities in geographic access to breast cancer screening

“…This nding is consistent with other research, which has found that among the greatest disparities in the geographic access to mammography facilities exist in small towns and rural areas. 12,52,58 When the results of these analyses are considered for the USPSTF guidelines with race-based screening demand speci cations, three additional sites were proposed for the southern part of the state and two additional sites were proposed for New Castle County in areas that have larger numbers of younger Black and other minority women. Finally, under the ACR demand speci cation, all ve new mammography sites were proposed for the southern, more rural part of the state.…”

“…This information was used to estimate site capacity, or how many screening mammograms a site could perform each year. Using a calculation by Young and colleagues, 52 and the de nition of maximum capacity of three mammograms per mammography unit per business hour, 53 capacity of a facility with one mammography unit was estimated at an average of 4,500 screenings per unit per year. For sites with more than one mammography unit this value was multiplied by the number of units at that site.…”

Barreiras e facilitadores para atenção à saúde de pessoas com câncer em uma comuna do norte do Chile: relatório qualitativo

“…Es decir, es posible resolver las restricciones geográficas con centros de baja complejidad, pero siempre los pacientes con cáncer deberán recurrir a centros de mayor complejidad. (21)(22)(23)…”