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J Med Screen. 2016 Mar;23(1):24-30. doi: 10.1177/0969141315591616. Epub 2015 Jun 15.

Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations.

Author information

Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109 Dept of Health Services, University of Washington School of Public Health; 825 Eastlake Avenue East, Seattle, WA 98109
Group Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101.
Dept of Radiology, University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109.
Dept of Internal Medicine, University of California, San Francisco School of Medicine; 1001 Potrero Ave, Box 1364, San Francisco, CA 94110.
Dept of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania; 423 Guardian Drive, Philadelphia, PA 19104.
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Dept of Medicine, Harvard Medical School; Dana Farber Harvard Cancer Institute; Dept of Social and Behavioral Sciences, Harvard School of Public Health; 1620 Tremont Street, Boston, MA 02120.
Dept of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico; 1201 Camino de Salud NE, 1 University of New Mexico, Albuquerque, NM, 87102.
Depts of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756.
Dept of Radiology, University of Wisconsin School of Medicine and Public Health; 600 Highland Avenue, Madison WI 53792.



Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations.


73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012.


We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women.


Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations.


Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use.


access; advanced breast imaging; breast cancer; disparities; screening mammography

[Available on 2017-03-01]
[Indexed for MEDLINE]
Free PMC Article

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