Potential and Realized Spatial Accessibility to Breast Cancer Services for Rural Underinsured Women across North Texas

Authors: Amy Hughes*, UTHealth Science Center at Houston, Sandi L Pruitt, UT Southwestern Medical Center, Simon C Lee, UT Southwestern Medical Center
Topics: Medical and Health Geography, Rural Geography, Spatial Analysis & Modeling
Keywords: spatial accessibility, access to care, breast cancer, mammography
Session Type: Paper
Day: 4/13/2018
Start / End Time: 8:00 AM / 9:40 AM
Room: Studio 7, Marriott, 2nd Floor
Presentation File: No File Uploaded


Rural North Texas counties lack infrastructure facilitating breast cancer prevention for underinsured women, which may result in women foregoing or delaying screening. Timely screening and diagnostic care may decrease morbidity and mortality for breast cancer by identifying cancers at earlier stages. Since 2012, the Breast Screening and Patient Navigation (BSPAN) program has connected 17,500 rural underinsured women across 35 counties in rural North Texas to breast cancer services. BSPAN delivers services via a hub-and-spoke model wherein patients contact the "hub" for help identifying providers, scheduling appointments, and remembering screenings. Women receive services at their local clinic of choice ("spoke"). The hub processes payments for services covered by federal, state, and philanthropic funders. Clinics serving underinsured patients are more common in urban (vs rural) areas. Given the paucity of rural breast cancer services providers across rural North Texas, locations of clinics and providers serving underinsured women likely do not coincide with residential population centers of underinsured women. Therefore, women receiving services via BSPAN may suffer high travel burden. Using the two-step floating catchment model and the publicly available Certified Mammography Facilities dataset, we first assess the potential spatial accessibility to breast cancer services across BSPAN counties. Next, we assess the realized spatial accessibility to breast cancer services using BSPAN program encounter data by creating an average street network travel time from the woman’s residence to the mammography clinic. We compare the spatial distributions of potential and realized spatial accessibility to identify areas not adequately serviced by current mammography facilities.

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