Flagging Disparities Helps Locate Best Places for Cancer Screening Sites

A new study from ChristianaCare’s Helen F. Graham Cancer Center & Research Institute provides a roadmap for states to identify where they can put more breast cancer screening sites, a move the study authors said could help close racial health disparities in screening.

The study, published in Breast Cancer Research, also flagged regions within Delaware, where ChristianaCare operates, with the poorest patient access to breast cancer screening. In particular, the researchers found that rural regions and places with more Black residents have poorer access to Breast Imaging Centers of Excellence (BICOEs).

These findings come as healthcare experts work to better understand racial health disparities and the forces behind them. This particular study zeroed in on disparities in breast cancer screenings based on patient access to screening centers, which can then turn into disparities in health outcomes, according to the study’s senior author, Scott Siegel, PhD, MHCDS.

“Ensuring equitable geographic access to screening mammography must be an important priority for reducing disparities in breast cancer outcomes,” Siegel, who is the director of Cancer Control & Population Sciences at the Graham Cancer Center, stated publicly.

“Our study had two objectives. Besides identifying where disparities in mammography screening exist, we went a step further to suggest what we might do to correct the issue, by pinpointing potential locations for additional screening sites.”

To flag current disparities, the team conducted a catchment analysis, which measures proximity to BICOEs within driving distance. The analysis showed that BICOEs are less accessible for people of color and those traveling from rural areas. In particular, for every standard deviation increase in the number of Black women in a census tract, the authors noted 68 percent fewer mammography units and 89 percent fewer BICOEs.

Meanwhile, even as rural counties accounted for 41 percent of the state’s population, they were home to only 22 percent of the state’s BICOEs.

Using those identified breast cancer screening access disparities, the researchers were able to create a formula for identifying the best locations to open up new breast cancer screening facilities.

Using recommendations from the USPSTF and census data, the researchers were able to identify which areas would have the most demand for breast cancer screening. From there, they added specifications based on race and rurality, which helped identify which counties would most benefit from another breast cancer screening location.

Importantly, these locations changed based on the criteria the researchers plugged into the formula. While just looking at USPSTF demand, the team determined a new facility would be good in the town of Millsboro. But when accounting for race, the formula recommended five new facilities.

Overall, by adding new care sites based on race-based specifications and geographic disparities, the researchers found they could reduce total driving time by 4 and 2 percent, respectively. This is a positive step forward, considering the role driving times play in discouraging patient care access.

Of course, other factors also drive racial and geographic health disparities in cancer screening access, but this study provides a good path forward for at least addressing the issue of proximity, the researchers said. Although the data focused on Delaware, the team said the research approach is replicable for other states and regions.