Geographic access to mammography facilities and frequency of mammography screening

Patricia I. Jewett, Ronald E. Gangnon, Elena Elkin, John M. Hampton, Elizabeth A. Jacobs, Kristen Malecki, James LaGro, Polly A. Newcomb, Amy Trentham-Dietz

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Purpose: To assess the association between geographic access to mammography facilities and women's mammography utilization frequency. Methods: Using data from the population-based 1995–2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50–74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups. Results: We found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values.01 and.005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09–1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer. Conclusions: Having at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.

Original languageEnglish (US)
Pages (from-to)65-71.e2
JournalAnnals of epidemiology
Issue number2
StatePublished - Feb 2018

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health grants R01 CA067264 , P30 CA014520 , and R01 CA047147 . The authors would like to thank Julie McGregor and Kathy Peck for study support and data collection, Felix Elwert for directions on using directed acyclic graphs, and Jaime Martindale for her ArcGIS support.

Publisher Copyright:
© 2017 Elsevier Inc.


  • Health services accessibility
  • Mammography
  • Spatial epidemiology


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