Mammography Capacity and Appointment Wait Times: Barriers to Breast Cancer Screening

Learning Objective: To assess the relationship between county mammography capacity and appointment wait times.

Background: Annual screening mammography is recommended for women age 40 and older at average risk of developing breast cancer. Recent declines in both national breast cancer screening rates and the number of certified mammography facilities have prompted concern about women's access to mammography. Our primary objective was to assess the impact of mammography resource capacity on appointment wait times.

Methods: We identified all mammography facilities in California, Connecticut, Georgia, Iowa, New Mexico and New York that were certified by the US Food and Drug Administration – a federal requirement for legal operation of a mammography facility – as of January 2008. Between April and September 2008, a representative at each facility was surveyed by telephone using a simulated-patient format. The survey included items regarding time until next available screening mammogram appointment, insurance copayment requirements and use of digital mammography. Appointment wait times were categorized as <1 week, 1-4 weeks, or >1 month. Mammography capacity was defined as the number of mammography machines per 10,000 women age 40 or older in each county, based on data obtained from the FDA. We estimated the impact of capacity on appointment wait time using generalized estimating equations to account for the clustering of facilities within counties

Results: We contacted 1,614 (86%) of 1,882 mammography facilities identified. The time until next available appointment for a screening mammogram was <1 week at 55% of facilities, 1-4 weeks at 34% of facilities, and >1 month at 11% of facilities. In the 6 states studied, median county-level mammography capacity was 2.0 machines per 10,000 women age 40 or older (interquartile range [IQR] 1.50 – 2.99) in 2007, higher than the median capacity of 1.64 (IQR 0 – 2.51) for all US counties. Facilities in counties with lower capacity had longer appointment wait times (p<0.01). Nearly all facilities stated that no copayment was required at the time of the mammogram visit. The adoption of digital mammogram technology was highest in Connecticut (64% of facilities) and lowest in New Mexico (28% of facilities).

Conclusion: In the 6 states studied, lower mammography capacity was associated with longer appointment wait times. These findings suggest that interventions to enhance mammography capacity in currently underserved areas may reduce appointment wait times, improving access to screening mammography.