Women in coastal cities with greater income levels and access to insurance may have a greater chance of catching their breast cancer early than those living in rural and inland metropolises.

That’s one possible scenario stemming from a new study that assessed mammogram utilization rates among women, 40 years and older, in 500 cities across the U.S.

"It has been shown that screening mammography use is generally higher in urban areas in comparison with rural areas, and so prior studies have focused on these rural disparities in screening," Dr. Eric Kim, MD, PGY-4 diagnostic radiology resident in the Department of Radiology at NYU Langone Health, told HCB News. "This study focuses on the urban disparities in screening mammography utilization by analyzing multiple variables expected to impact screening use in the 500 largest cities of the United States."

The second leading cause of death in the U.S., breast cancer mortality has been shown to decrease with the rise of mammographic screening.

Utilization of screening rose from 28.7 percent to 65.3 percent for women, 40 and up, between 1987 and 2015. Those in rural areas, however, face a greater lack of access to care providers, long distances to imaging facilities and other physical barriers. The rate for women in rural parts in 2004 was 71.1 percent, compared to 75.4 percent for those in city environments, according to the National Center for Health Statistics.

The authors used public data from the 500 Cities Project to examine disparities in screening mammography utilization at the city level, assessing survey data on health risks, utilization of screening mammography by more than 127,000 women, and data from the U.S. Census Bureau, which includes income, educational attainment, race and employment. They then matched screening mammography utilization to variables expected to affect screening in the 500 Cities Project data.

Mean utilization for city screening mammography was found to be 77.7 percent, with New England cities exhibiting the highest utilization rate at 83.7 percent. The lowest was found among cities in mountain states, a north-south corridor that travels from Montana, Idaho and Wyoming to Arizona and New Mexico, at 73.6 percent.

In addition, the study tied preventative health screenings and household income to greater likelihood of screening utilization, and labeled factors such as obesity, poverty and lack of private insurance as barriers. Independent predictors for such exams included Pap test compliance, being of Asian descent, access to private insurance and geographic region of residency.

"In the future, we intend to link city-level screening mammography utilization with breast cancer incidence and mortality data," said Kim. "Although we expect higher city-level screening utilization to negatively correlate with breast cancer mortality, it will be interesting to see if that is what the data shows. We ultimately hope to be able to use our analysis to target urban regions where intervention is paramount."

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