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ASSESSMENT OF THE AVAILABILITY OF MAMMOGRAPHY SERVICES - Final Report

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Prepared in partial fulfillment of the requirements of Task Order 1
Contract No. 223-94-8031

Prepared by:

Eastern Research Group, Inc.
110 Hartwell Ave.
Lexington, MA 02421

Prepared for:

Office of Policy, Planning, and Legislation
Office of the Commissioner
Food and Drug Administration
Parklawn Building
5600 Fishers Lane
Rockville, MD 20857


December 18, 2001


Assessment of the Availability
of Mammography Services


Recent news reports have suggested that closures and service curtailments by mammography providers have made it more difficult for women to schedule and obtain mammograms within a reasonable length of time.1 The possible shortage of mammography services has raised concerns that some women are not receiving needed mammograms due to limitations in access. To examine the issue of mammography access, ERG first reviewed data provided by FDA describing changes in the numbers and distribution of mammography facilities. ERG then compared these data with statistics on the number of women in age groups for which annual mammograms are recommended and with estimates of changes in the prevalence of women receiving mammograms. This analysis provides an overview of the availability of mammography services and of the changes in the demand for and supply of mammograms in recent years.


 

1. See, for example, "Need a mammogram? It could take a while: Delays reach crisis levels as women wait up to five months for a routine screening," Time Magazine, March 12, 2001; "Experts foresee crisis in access to breast tests," New York Times, November 30, 2000; and "As more women seek mammograms, many have to wait months, low payments from insurers, influx of patients put breast clinics in a bind," Wall Street Journal, October 30, 2000.

 

Mammography Facilities

FDA's database of mammography facilities shows 9,512 certified domestic operations as of June 20012. By comparison, there were 9,558 certified facilities (46 more) on January 1, 2000, and 9,314 such facilities (198 fewer) on January 1, 1999. Fewer certified facilities are currently operating than were open in either 1997 or 1994. According to mammography facility databases previously provided to ERG, an estimated 10,119 and 9,956 facilities were open in 1994 and 1997, respectively3. These statistics show that nationally the number of mammography facilities has declined by 4.5 percent since 1997 and 6.0 percent since 19944.

Table 1 shows the distribution of mammography facilities by state and by year, while Table 2 shows the percentage changes by state from 1994 and 1997 to the present. Although the total number of facilities declined during the late 1990s, 19 states experienced a growth in mammography operations, accounting for 116 additional facilities since 1997. Thirty-one states (including the District of Columbia) lost a total of 560 facilities since 1997. (Facilities were unchanged in one state.) Facility closures were most pronounced in several New England states (Connecticut, Massachusetts, and Rhode Island) and in New Mexico, California, Maryland, and the District of Columbia. Since 1997, these states have experienced declines in facilities that range from 11.3 to 25.0 percent.


 

2. This count excludes mammography facilities in Puerto Rico and other overseas locations and federal facilities operated by the Department of Veterans Affairs.

3. These statistics are based on Mammography Program Reporting and Information System facility databases dated December 15, 1994, and March 19, 1997. See Eastern Research Group, Economic Impact Analysis of Regulations Under the Mammography Quality Standards Act of 1992, Appendix E: Analysis of Newly Closed and Newly Opened Mammography Facilities.
Prepared for the U.S. FDA, Office of Planning and Evaluation. Task Order No.1, Contract No. 223-94-8031. October 7, 1997.

4. Recent FDA analyses of the mammography facility database have found that the 1994 facility counts were inflated due to duplicate listings of facilities that had received more than one accreditation. Thus the 1994 count overstates the true number of facilities that were operating at that time. Those facilities with duplicate records were located in California and Iowa. Personal communication with Tim Haran, Chief, Information Management Branch, Division of Mammography Quality and Radiation Programs, Office of Communication, Education, and Radiation Programs
Center for Devices and Radiological Health, Food and Drug Administration. October 10, 2001.

In addition to the reduction in facilities, the number of facilities per 10,000 females 40 years of age or over has also declined in most states. Table 3 presents estimates of these facility-population ratios for 1999 and 1997, based on population data from the U.S. Bureau of the Census. (Census data released thus far are not sufficiently detailed to allow the calculation of the ratios for the year 2000.) In 1999, the median for all states was 1.57 facilities per 10,000 women, a decline of 9.2 percent from 1997. Among states, the 1999 ratio ranged from 3.03 in Alaska to 1.23 in California. Only five states experienced an increase in the facility/population ratio between 1997 and 1999.

Demand for Mammography Services

The actual demand for mammography services depends on the number of females who are referred for or seek screening or diagnostic mammograms. The FDA mammography facility database contains information on the number of procedures performed by each facility. These statistics, however, are based on submittals by facilities at the time of their accreditation. They may, therefore, underestimate the current level of services if demand is increasing over time. Surveys conducted by the Centers for Disease Control and Prevention (CDC) provide an alternative source for estimates of the number of mammograms provided by mammography facilities. CDC's Behavioral Risk Factor Surveillance Survey (BRFSS), conducted annually, collects information on the prevalence of females who seek clinical breast exams and receive mammograms. ERG used the results from the 1997 and 2000 BRFSS to tabulate, by state, the number of females 40 years of age and older who had a mammogram in the last 12 months. These statistics were then divided by the number of facilities to derive a measure of the average number of mammograms per facility provided in each state.

Table 4 shows the estimated number of mammograms provided in each state and the corresponding ratio of mammograms to facilities. Overall, 19.0 percent (the overall median) more women over 40 years of age received mammograms in 2000 than in 1997. During the same period, the estimated number of mammograms per facility increased by 20.9 percent. Only two states (Alaska and Wyoming) showed a decline in the number of mammograms per facility. These results clearly indicate that mammography facilities met increased demand for services without a corresponding increase in the number of facilities. During this period, mammography providers either had excess capacity or expanded capacity in the face of increased demand.

Additional tabulations from the CDC's surveys provide insights about the level of demand for mammography services. Table 5 shows the estimates of the percentage of females 40 years and older that had a mammogram in the previous 12 months. In 1997, the median for all states was 29.9 percent for women 40 to 49 years old and 57.0 percent for women 50 years old and older. By 2000, these percentages had increased to 36.3 percent for the younger age group and 64.7 percent for older women. Among individual states, the increase in the percentage of women over 40 receiving mammograms in the previous 12 months ranged from 1.9 percentage points (Georgia) to 23.0 percentage points (Arizona). The median increase was 7.7 points. Thus, despite the decline in the number of facilities over the 1997 to 2000 period and the increase in the number of women in the over-40 age group, an increasing percentage (and number) of women are receiving mammograms each year.

Statistical tests show virtually no correlation between the percentage change in facilities and the change in the percentage of women receiving mammograms in the previous 12 months. When states are ranked first by the percentage change in those receiving mammograms and then by the percentage change in facilities, the resultant Spearman rank-order correlation coefficient is 0.034, where 1.0 indicates perfect rank-order correlation5. In fact, the only statistically significant correlations observed for the change in the percentage receiving mammograms were negative relationships with (1) the percentage receiving mammograms in 1997 and (2) the population change between 1997 and 1999. Thus, states with higher rates of women receiving mammograms in 1997 and with higher population growth rates were more likely to have smaller increases in the percentage of women getting mammograms. Table 6 shows these correlation statistics.


5. With 51 observations, a correlation coefficient of about 0.29 is necessary to reject, at the 95-percent confidence level, the hypothesis that the two variables are unrelated.

Mammography Access

The CDC surveys do not directly address the question of whether delays in scheduling negatively affect the numbers of women seeking mammograms. The surveys do, however, contain information about whether women have had clinical breast exams in the previous 12 months. By combining these responses with responses about whether the respondent had a mammogram in the previous 12 months, we can construct estimates of the percentages of those women who had a clinical exam in the last year and received a mammogram in the same period. Since a breast exam is often a precondition for seeking a mammogram, this statistic comes closer to addressing the question of whether women do not obtain mammograms because of difficulties in scheduling or because of poor access to mammography services.6


 

6. Some women may "self refer" themselves for a mammogram.

Table 7 shows these statistics by state for 1997 and 2000. Based on the median across all states, 66.1 percent of women 40 and older in 1997 who had a clinical breast exam also received a mammogram in the last 12 months. The median was 77.8 percent for women 50 and older and 43.0 percent for women 40 to 49. By 2000, these percentages had increased to 84.9 percent for the older women and 49.1 percent for the younger group, with an overall median of 74.1 percent. In 2000, therefore, only 15.1 percent of older women who had a breast exam failed to receive a mammogram, an absolute decrease of 7.1 percentage points from 1997. Among states, the percentages receiving mammograms ranged from 77.2 percent to 91.4 percent for women 50 and over and from 36.0 to 63.9 percent for women 40 to 49. Thus, despite the decline in facilities in most states, the percentage of women with clinical breast exams who also received mammograms in the same year increased by between 2.0 and 15.7 percentage points, with a median increase of 6.8 points.

Summary

In summary, the data from the FDA mammography database, in combination with population data, show that the number of mammography facilities has declined in most states while the population of potential recipients of mammography services has increased. This suggests an increased demand relative to the supply of mammography services. The number of facilities by itself, however, does not capture the effective capacity of mammography providers. Data from the CDC surveys, when combined with the FDA data, show that providers conducted substantially more mammograms per facility in 2000 than they did in 1997. Other CDC survey data describing the prevalence of women who receive clinical breast exams and mammograms show that an increasing percentage of women in the 40 and older age group have recently obtained a mammogram. Furthermore, when only women receiving clinical breast exams are considered, an increased percentage received a mammogram in the same year. The CDC data thus fail to support claims that closures of mammography facilities or increased demand for mammography services have negatively affected the number of women obtaining mammograms. This analysis, however, has examined only the period 1997 through 2000. Recent changes in the availability of mammography services might have had impacts not observable from these data. A recently released survey of mammography providers, however, supports the findings presented here. This survey of more than 9,900 mammography facilities found that the typical lead time to schedule a screening mammogram is longer than a week for 34 percent of facilities, but longer than a month for only 8 percent of facilities7. The survey findings suggest that any problems with mammography access are localized in nature rather than widespread.


 

7 Survey of 9.908 mammography facilities conducted in 2000 by IMV Medical Information Division, Inc. A summary of the survey is available at www.imvlimited.com/mid/news_c.html. Accessed July 25, 2001.

 TABLE 1

Number of Mammography Facilities by State and Year

  Currently Operating Operating Operating Operating Operating
State Operating 1/1/01 1/1/00 1/1/99 1997 1994
                       
Alabama 159   161   157   151   161   159
Alaska 33   33   33   32   30   29
Arizona 151   157   157   155   163   161
Arkansas 113   109   105   101   110   109
California 794   825   828   833   959   1091
Colorado 115   116   112   112   117   123
Connecticut 158   162   166   168   182   180
Delaware 27   27   26   26   27   28
District of Columbia 24   24   25   26   32   34
Florida 503   524   506   488   539   563
Georgia 268   268   270   269   290   289
Hawaii 41   42   42   41   44   43
Idaho 48   48   45   43   44   41
Illinois 424   441   435   420   443   438
Indiana 231   231   230   219   234   227
Iowa 149   147   148   143   142   142
Kansas 136   137   137   123   137   144
Kentucky 174   173   175   170   165   170
Louisiana 170   173   164   151   163   162
Maine 63   62   57   55   57   56
Maryland 157   156   159   165   195   198
Massachusetts 205   205   209   218   231   224
Michigan 339   344   341   350   356   369
Minnesota 210   212   206   197   198   190
Mississippi 106   102   98   100   99   101
Missouri 187   192   199   194   206   213
Montana 50   48   46   45   52   50
Nebraska 93   92   90   88   88   83
Nevada 61   57   54   51   62   62
New Hampshire 49   49   48   44   47   49
New Jersey 283   290   292   282   290   291
New Mexico 48   48   50   48   56   57
New York 710   712   709   688   748   763
North Carolina 253   253   251   242   246   242
North Dakota 42   44   41   38   40   42
Ohio 445   455   456   455   467   451
Oklahoma 105   106   106   103   111   114
Oregon 98   98   99   99   102   104
Pennsylvania 447   450   453   436   488   507
Rhode Island 47   49   50   50   53   50
South Carolina 126   132   134   119   121   121
South Dakota 49   48   47   46   45   41
Tennessee 211   212   210   196   200   195
Texas 583   581   565   549   585   575
Utah 47   48   48   43   48   49
Vermont 19   19   18   18   18   17
Virginia 214   216   221   213   226   239
Washington 181   187   188   178   189   189
West Virginia 85   87   85   83   90   87
Wisconsin 253   252   240   225   236   233
Wyoming 28   28   27   25   24   24
                       
Total 9,512   9,632   9,558   9,314   9,956   10,119
                       

Source: FDA Mammography Facility Database.

 Table 2
Percentage Change in Number of Mammography Facilities, by State 

State     1997 to Present   1994 to Present
           
Alabama     -1.2%   0.0%
Alaska     10.0%   13.8%
Arizona     -7.4%   -6.2%
Arkansas     2.7%   3.7%
California     -17.2%   -27.2%
Colorado     -1.7%   -6.5%
Connecticut   -13.2%   -12.2%
Delaware     0.0%   -3.6%
District of Columbia   -25.0%   -29.4%
Florida     -6.7%   -10.7%
Georgia     -7.6%   -7.3%
Hawaii     -6.8%   -4.7%
Idaho     9.1%   17.1%
Illinois     -4.3%   -3.2%
Indiana     -1.3%   1.8%
Iowa     4.9%   4.9%
Kansas     -0.7%   -5.6%
Kentucky     5.5%   2.4%
Louisiana     4.3%   4.9%
Maine     10.5%   12.5%
Maryland     -19.5%   -20.7%
Massachusetts   -11.3%   -8.5%
Michigan     -4.8%   -8.1%
Minnesota     6.1%   10.5%
Mississippi     7.1%   5.0%
Missouri     -9.2%   -12.2%
Montana     -3.8%   0.0%
Nebraska     5.7%   12.0%
Nevada     -1.6%   -1.6%
New Hampshire   4.3%   0.0%
New Jersey     -2.4%   -2.7%
New Mexico   -14.3%   -15.8%
New York     -5.1%   -6.9%
North Carolina   2.8%   4.5%
North Dakota   5.0%   0.0%
Ohio     -4.7%   -1.3%
Oklahoma     -5.4%   -7.9%
Oregon     -3.9%   -5.8%
Pennsylvania   -8.4%   -11.8%
Rhode Island   -11.3%   -6.0%
South Carolina   4.1%   4.1%
South Dakota   8.9%   19.5%
Tennessee     5.5%   8.2%
Texas     -0.3%   1.4%
Utah     -2.1%   -4.1%
Vermont     5.6%   11.8%
Virginia     -5.3%   -10.5%
Washington   -4.2%   -4.2%
West Virginia   -5.6%   -2.3%
Wisconsin     7.2%   8.6%
Wyoming     16.7%   16.7%
           
Median, all states   -1.7%   -2.3%
           

Source: FDA Mammography Facility Database.


 Table 3
Number of Facilities per 10,000 Women, 40 Years of Age and Over, by State: 1999 and 1997

State   1997   1999[a]   Change 1997-1999
             
Alabama   1.61   1.48   -7.6%
Alaska   2.94   3.03   3.1%
Arizona   1.66   1.49   -10.2%
Arkansas   1.86   1.70   -8.8%
California   1.50   1.23   -18.0%
Colorado   1.39   1.24   -10.7%
Connecticut 2.34   2.11   -9.8%
Delaware   1.65   1.51   -8.5%
District of Columbia 2.49   1.92   -22.7%
Florida   1.45   1.28   -12.1%
Georgia   1.87   1.64   -12.4%
Hawaii   1.67   1.50   -10.1%
Idaho   1.77   1.67   -5.8%
Illinois   1.67   1.56   -6.5%
Indiana   1.77   1.65   -7.0%
Iowa   2.09   2.09   0.1%
Kansas   2.34   2.16   -7.9%
Kentucky   1.85   1.86   0.5%
Louisiana   1.73   1.61   -6.5%
Maine   1.93   1.83   -4.9%
Maryland   1.74   1.40   -20.0%
Massachusetts 1.62   1.45   -10.5%
Michigan   1.64   1.54   -5.9%
Minnesota   1.95   1.90   -2.5%
Mississippi   1.66   1.60   -3.6%
Missouri   1.66   1.53   -7.5%
Montana   2.54   2.14   -15.6%
Nebraska   2.37   2.33   -1.4%
Nevada   1.79   1.38   -22.9%
New Hampshire 1.86   1.74   -6.6%
New Jersey   1.53   1.46   -4.3%
New Mexico 1.55   1.30   -16.3%
New York   1.77   1.61   -8.9%
North Carolina 1.46   1.39   -4.6%
North Dakota 2.78   2.69   -3.3%
Ohio   1.80   1.71   -4.9%
Oklahoma   1.46   1.33   -9.1%
Oregon   1.35   1.26   -6.7%
Pennsylvania 1.63   1.46   -10.7%
Rhode Island 2.26   2.08   -7.8%
South Carolina 1.42   1.41   -0.6%
South Dakota 2.78   2.79   0.4%
Tennessee   1.60   1.57   -2.4%
Texas   1.51   1.35   -10.6%
Utah   1.40   1.27   -9.6%
Vermont   1.34   1.29   -4.1%
Virginia   1.54   1.42   -7.9%
Washington 1.57   1.45   -7.7%
West Virginia 1.95   1.78   -8.5%
Wisconsin   2.03   1.94   -4.7%
Wyoming   2.31   2.40   4.1%
             
Median, all states 1.73   1.57   -9.2%
Maximum   2.94   3.03   4.1%
Minimum   1.34   1.23   -22.9%
             

Source: FDA Mammography Facility Database; U.S. Bureau of the Census population estimates. Detailed population estimates not available for 2000.
[a] Based on the average number of facilities open during 1999.

 Table 4
Mammograms by State: 2000 and 1997

                         
   
Number of Mammograms
   
Mammograms per Facility
State   1997   2000   Change 1997-2000     1997 2000[a]   Change 1997-2000
                         
Alaska   71,329   77,561   8.7%     443 488   10.1%
Alabama   656,797   685,987   4.4%     21,893 20,787   -5.1%
Arizona   520,294   870,851   67.4%     3,192 5,547   73.8%
Arkansas   289,701   403,036   39.1%     2,634 3,767   43.0%
California   4,219,730   4,894,071   16.0%     4,400 5,921   34.6%
Colorado   513,556   603,597   17.5%     4,389 5,295   20.6%
Connecticut 523,607   648,065   23.8%     2,877 3,952   37.4%
District of Columbia 89,561   100,007   11.7%     3,317 3,774   13.8%
Delaware   120,393   151,500   25.8%     3,762 6,184   64.4%
Florida   2,654,245   2,947,370   11.0%     4,924 5,723   16.2%
Georgia   1,084,512   1,221,901   12.7%     3,740 4,542   21.5%
Hawaii   179,940   199,975   11.1%     4,090 4,761   16.4%
Iowa   371,219   473,081   27.4%     8,437 10,174   20.6%
Idaho   128,210   151,677   18.3%     289 346   19.7%
Illinois   1,661,097   2,014,576   21.3%     7,099 8,740   23.1%
Indiana   780,326   947,962   21.5%     5,495 6,427   17.0%
Kansas   360,660   422,202   17.1%     2,633 3,082   17.1%
Kentucky   563,798   671,122   19.0%     3,417 3,857   12.9%
Louisiana   623,675   736,965   18.2%     3,826 4,374   14.3%
Massachusetts 1,030,159   1,210,546   17.5%     18,073 20,345   12.6%
Maryland   850,915   942,654   10.8%     4,364 5,985   37.2%
Maine   190,348   218,709   14.9%     824 1,057   28.2%
Michigan   1,490,070   1,775,562   19.2%     4,186 5,184   23.9%
Minnesota   606,215   737,089   21.6%     3,062 3,527   15.2%
Missouri   712,248   901,631   26.6%     7,194 9,016   25.3%
Mississippi   329,960   376,079   14.0%     1,602 1,924   20.1%
Montana   111,030   137,630   24.0%     2,135 2,928   37.1%
North Carolina 1,123,628   1,371,983   22.1%     12,769 15,077   18.1%
North Dakota 87,497   95,217   8.8%     1,411 1,716   21.6%
Nebraska   205,249   268,880   31.0%     4,367 5,544   27.0%
New Hampshire 171,582   201,095   17.2%     592 691   16.8%
New Jersey   1,262,470   1,514,622   20.0%     22,544 30,911   37.1%
New Mexico 202,157   248,780   23.1%     270 350   29.6%
Nevada   218,622   292,841   33.9%     889 1,162   30.8%
New York   3,006,550   3,384,130   12.6%     75,164 79,627   5.9%
Ohio   1,644,999   1,963,561   19.4%     3,522 4,311   22.4%
Oklahoma   410,138   496,664   21.1%     3,695 4,686   26.8%
Oregon   467,291   536,200   14.7%     4,581 5,444   18.8%
Pennsylvania 1,870,454   2,159,221   15.4%     3,833 4,782   24.8%
Rhode Island 161,944   200,637   23.9%     3,056 4,053   32.7%
South Carolina 474,666   671,933   41.6%     3,923 5,052   28.8%
South Dakota 99,862   113,612   13.8%     2,219 2,392   7.8%
Tennessee   822,266   942,073   14.6%     4,111 4,465   8.6%
Texas   2,306,786   2,901,529   25.8%     3,943 5,064   28.4%
Utah   198,028   235,049   18.7%     4,126 4,897   18.7%
Virginia   920,460   1,115,348   21.2%     51,137 60,289   17.9%
Vermont   74,411   93,402   25.5%     329 427   29.8%
Washington 722,013   850,678   17.8%     3,820 4,537   18.8%
Wisconsin   650,724   832,968   28.0%     7,230 9,686   34.0%
West Virginia 257,001   323,929   26.0%     1,089 1,317   20.9%
Wyoming   58,501   63,733   8.9%     2,438 2,318   -4.9%
                         
Median, all states 513,556   648,065   19.0%     3,820 4,686   20.9%
                         

Source: CDC, Behavioral Risk Factor Surveillance Survey, 1997 and 2000; FDA Mammography Facility Database
[a] Based on the average number of facilities open during 2000.

 

 Table 5
Percentage of Women Receiving a Mammogram in the Previous 12 Months by Age: 1997 and 2000

 
1997
 
2000
 
Change, 1997 to 2000
State 40 to 49 Years   50 Years and Over   40 Years and Over   40 to 49 Years   50 Years
and Over
  40 Years and Over   40 to 49 Years   50 Years and Over   40 Years and Over
                                   
Alabama 35.7%   54.8%   49.3%   31.7%   61.2%   52.9%   -4.0%   6.4%   3.6%
Alaska 28.4%   66.4%   50.2%   32.0%   66.8%   53.2%   3.7%   0.5%   3.1%
Arizona 31.7%   44.1%   40.4%   45.9%   70.5%   63.4%   14.2%   26.4%   23.0%
Arkansas 28.3%   41.4%   37.9%   34.4%   59.7%   53.1%   6.1%   18.3%   15.3%
California 29.0%   60.1%   49.7%   30.0%   65.6%   54.1%   1.0%   5.5%   4.4%
Colorado 33.5%   57.8%   49.3%   29.2%   63.9%   52.5%   -4.2%   6.2%   3.1%
Connecticut 32.7%   61.7%   52.9%   43.6%   74.6%   65.5%   10.9%   13.0%   12.6%
Delaware 38.8%   64.6%   56.8%   41.9%   77.0%   66.8%   3.0%   12.5%   10.0%
District of Columbia 33.4%   62.0%   53.2%   48.2%   65.1%   59.9%   14.8%   3.1%   6.8%
Florida 33.4%   66.2%   57.7%   37.0%   68.4%   60.4%   3.6%   2.3%   2.6%
Georgia 36.9%   58.6%   51.5%   34.1%   62.3%   53.4%   -2.9%   3.8%   1.9%
Hawaii 36.7%   62.7%   54.6%   41.6%   67.7%   60.0%   5.0%   4.9%   5.4%
Idaho 19.2%   50.2%   40.6%   23.5%   54.4%   45.5%   4.3%   4.1%   4.8%
Illinois 28.5%   57.6%   48.8%   40.8%   64.7%   57.6%   12.3%   7.0%   8.8%
Indiana 35.2%   52.1%   47.1%   36.8%   62.8%   55.4%   1.6%   10.7%   8.2%
Iowa   29.9%   49.2%   43.9%   34.5%   64.4%   56.6%   4.6%   15.2%   12.7%
Kansas 33.7%   55.8%   49.2%   35.6%   63.6%   55.5%   1.9%   7.7%   6.3%
Kentucky 32.9%   55.5%   48.8%   38.5%   64.3%   56.9%   5.5%   8.8%   8.1%
Louisiana 32.2%   57.0%   49.3%   44.4%   66.2%   59.7%   12.2%   9.2%   10.4%
Maine 26.5%   63.7%   52.5%   36.3%   69.9%   60.2%   9.8%   6.2%   7.7%
Maryland 35.7%   69.8%   58.6%   39.0%   72.3%   61.8%   3.3%   2.6%   3.2%
Massachusetts 39.1%   65.5%   57.4%   43.8%   73.6%   64.8%   4.6%   8.1%   7.4%
Michigan 34.9%   63.3%   54.5%   42.7%   71.2%   62.9%   7.9%   8.0%   8.4%
Minnesota 25.9%   57.3%   47.6%   37.8%   62.4%   55.1%   11.9%   5.1%   7.5%
Mississippi 29.0%   48.0%   42.4%   28.0%   53.3%   46.0%   -1.0%   5.2%   3.6%
Missouri 25.0%   53.1%   45.1%   34.8%   63.1%   55.2%   9.7%   10.0%   10.1%
Montana 29.3%   51.2%   44.5%   30.7%   64.6%   54.9%   1.4%   13.4%   10.4%
Nebraska 26.9%   51.2%   44.1%   40.1%   61.6%   55.5%   13.2%   10.3%   11.3%
Nevada 22.5%   55.0%   44.8%   28.6%   64.5%   53.5%   6.1%   9.5%   8.8%
New Hampshire 37.0%   63.2%   54.7%   42.5%   67.3%   59.5%   5.5%   4.0%   4.9%
New Jersey 37.1%   56.3%   50.5%   41.0%   67.6%   60.0%   4.0%   11.4%   9.5%
New Mexico 28.5%   53.1%   45.1%   32.5%   62.1%   52.8%   4.0%   9.0%   7.7%
New York 36.2%   63.2%   55.2%   40.8%   69.2%   61.0%   4.6%   6.0%   5.8%
North Carolina 37.0%   58.2%   51.8%   36.4%   66.9%   58.0%   -0.6%   8.6%   6.1%
North Dakota 32.8%   57.0%   49.8%   35.4%   64.4%   56.1%   2.5%   7.4%   6.3%
Ohio   29.9%   58.6%   50.1%   39.3%   68.0%   59.8%   9.4%   9.4%   9.7%
Oklahoma 27.0%   47.4%   41.7%   34.5%   57.9%   51.4%   7.5%   10.4%   9.7%
Oregon 26.1%   60.1%   49.7%   28.4%   65.9%   55.0%   2.3%   5.8%   5.3%
Pennsylvania 37.3%   54.6%   49.9%   41.7%   64.3%   58.3%   4.4%   9.7%   8.4%
Rhode Island 34.8%   63.6%   55.1%   44.7%   73.2%   65.1%   9.9%   9.6%   10.0%
South Carolina 25.8%   51.4%   43.5%   36.1%   66.8%   57.9%   10.4%   15.5%   14.4%
South Dakota 36.6%   55.2%   49.9%   37.1%   64.7%   57.1%   0.5%   9.5%   7.2%
Tennessee 29.6%   58.9%   50.4%   36.5%   64.8%   56.7%   6.9%   5.9%   6.4%
Texas 27.9%   52.3%   44.3%   33.8%   59.8%   51.6%   5.9%   7.5%   7.3%
Utah   24.7%   51.9%   42.6%   28.4%   55.5%   46.7%   3.7%   3.6%   4.1%
Vermont 22.4%   56.2%   45.3%   31.7%   65.5%   55.2%   9.3%   9.3%   9.9%
Virginia 28.8%   57.1%   47.4%   38.3%   63.3%   55.5%   9.5%   6.2%   8.1%
Washington 25.3%   57.2%   46.8%   33.0%   60.5%   52.0%   7.6%   3.3%   5.2%
West Virginia 28.1%   51.7%   45.4%   35.4%   63.6%   56.4%   7.3%   11.8%   11.0%
Wisconsin 24.4%   54.4%   45.3%   34.3%   64.7%   55.9%   9.9%   10.3%   10.6%
Wyoming 27.0%   52.8%   44.3%   26.6%   58.3%   48.6%   -0.4%   5.6%   4.3%
                                     
All States                                  
  Median 29.9%   57.0%   49.3%   36.3%   64.7%   56.1%   5.0%   8.0%   7.7%
  Maximum 39.1%   69.8%   58.6%   48.2%   77.0%   66.8%   14.8%   26.4%   23.0%
  Minimum 19.2%   41.4%   37.9%   23.5%   53.3%   45.5%   -4.2%   0.5%   1.9%
                                     


Source: CDC, Behavioral Risk Factor Surveillance Survey, 1997 and 2000.

 Table 6

Correlation Coefficients for the Change in the Percentage of Women 40 and Older who
Received Mammograms in the Previous 12 Months

Spearman Rank-Order Correlation Coefficient
Variables Change in the percentage of women 40 and older who received mammograms in the previous 12 months, 1997 to 2000
Percentage change in number of mammography facilities, 1997 to present -0.034
Percentage change in population of women 40 and older, 1997 to 1999 -0.401*
Percentage of women 40 and older who received a mammogram in the previous 12 months, 1997 -0.334**
Mammography facilities per 10,000 women 40 and older, 1997 0.164
*Statistically significant at the 99 percent level.
**Statistically significant at the 95 percent level.

 

 Table 7
Percentage of Women With a Breast Exam in the Last Year Who Also Received a Mammogram, 1997 and 2000

 
1997
 
2000
 
Change, 1997 to 2000
State 40 to 49 Years   50 Years and Over   40 Years and Over   40 to 49 Years   50 Years
and Over
  40 Years and Over   40 to 49 Years   50 Years and Over   40 Years and Over
                                   
Alabama 46.3%   81.8%   70.2%   46.8%   86.4%   74.9%   0.6%   4.6%   4.8%
Alaska 37.6%   81.2%   63.1%   40.5%   86.4%   67.4%   2.9%   5.2%   4.3%
Arizona 49.8%   71.7%   65.0%   63.9%   86.9%   80.7%   14.1%   15.2%   15.7%
Arkansas 47.3%   71.3%   64.5%   51.3%   85.1%   76.2%   4.0%   13.8%   11.7%
California 44.1%   81.5%   69.7%   42.0%   85.4%   71.7%   -2.0%   4.0%   2.0%
Colorado 46.4%   78.4%   67.0%   39.1%   84.7%   69.8%   -7.3%   6.3%   2.8%
Connecticut 41.2%   82.5%   68.6%   50.7%   88.7%   77.5%   9.5%   6.2%   8.9%
Delaware 49.9%   81.8%   72.2%   49.0%   91.4%   78.9%   -0.9%   9.6%   6.7%
District of Columbia 39.1%   72.9%   62.3%   55.4%   85.5%   75.2%   16.3%   12.6%   12.9%
Florida 43.8%   82.5%   72.5%   52.9%   86.1%   78.2%   9.2%   3.6%   5.7%
Georgia 43.5%   74.1%   63.2%   46.4%   81.1%   70.3%   2.9%   7.0%   7.1%
Hawaii 48.5%   80.1%   70.8%   51.9%   87.3%   76.8%   3.4%   7.1%   6.0%
Idaho 31.5%   75.6%   61.9%   36.0%   78.4%   66.3%   4.5%   2.8%   4.4%
Illinois 39.7%   79.7%   67.0%   50.0%   84.7%   73.8%   10.3%   4.9%   6.8%
Indiana 47.0%   74.1%   65.6%   48.5%   86.0%   74.5%   1.5%   12.0%   9.0%
Iowa   43.2%   75.5%   66.2%   46.4%   84.4%   74.3%   3.2%   8.9%   8.1%
Kansas 42.9%   75.6%   65.1%   48.2%   85.2%   74.3%   5.4%   9.6%   9.2%
Kentucky 48.6%   83.8%   73.0%   54.5%   86.0%   77.3%   6.0%   2.2%   4.3%
Louisiana 41.3%   77.9%   65.8%   57.4%   86.4%   77.4%   16.2%   8.5%   11.6%
Maine 40.9%   78.9%   68.6%   49.2%   86.1%   75.7%   8.3%   7.2%   7.2%
Maryland 43.1%   86.5%   71.9%   45.5%   87.7%   74.1%   2.4%   1.2%   2.2%
Massachusetts 46.9%   83.7%   71.9%   53.7%   86.9%   77.3%   6.9%   3.1%   5.4%
Michigan 50.4%   81.1%   72.0%   55.3%   87.5%   77.4%   5.0%   6.4%   5.3%
Minnesota 37.1%   79.3%   66.8%   49.1%   84.2%   73.2%   12.0%   4.9%   6.4%
Mississippi 43.5%   69.3%   61.4%   38.8%   77.2%   65.1%   -4.7%   7.9%   3.7%
Missouri 32.7%   77.2%   62.6%   46.8%   84.3%   73.3%   14.1%   7.1%   10.7%
Montana 43.9%   72.7%   64.3%   40.6%   83.6%   72.0%   -3.3%   10.9%   7.6%
Nebraska 35.8%   75.6%   62.8%   52.7%   87.1%   76.6%   16.9%   11.6%   13.8%
Nevada 37.8%   76.0%   64.6%   41.5%   84.3%   71.3%   3.7%   8.3%   6.7%
New Hampshire 50.1%   82.9%   72.0%   54.3%   86.7%   76.9%   4.1%   3.9%   4.9%
New Jersey 46.6%   79.0%   68.5%   52.8%   87.2%   77.1%   6.2%   8.2%   8.6%
New Mexico 42.0%   76.0%   64.7%   44.1%   83.1%   70.8%   2.2%   7.1%   6.1%
New York 44.6%   76.9%   67.2%   49.6%   86.2%   75.2%   5.0%   9.3%   8.0%
North Carolina 48.6%   78.8%   69.5%   48.2%   83.6%   73.6%   -0.4%   4.8%   4.1%
North Dakota 45.6%   81.5%   70.3%   49.3%   85.4%   75.2%   3.7%   3.9%   4.9%
Ohio   40.2%   77.2%   66.3%   55.2%   87.2%   78.3%   15.0%   9.9%   12.0%
Oklahoma 41.2%   63.4%   57.5%   49.3%   80.4%   71.8%   8.1%   17.0%   14.3%
Oregon 37.5%   77.8%   66.0%   42.3%   86.0%   73.9%   4.7%   8.2%   7.9%
Pennsylvania 47.2%   79.3%   69.6%   51.9%   83.3%   74.2%   4.7%   4.0%   4.6%
Rhode Island 46.2%   78.9%   69.3%   53.5%   87.5%   77.8%   7.3%   8.6%   8.5%
South Carolina 36.6%   75.4%   63.3%   45.4%   84.7%   73.3%   8.8%   9.3%   10.0%
South Dakota 49.6%   77.1%   69.0%   49.8%   82.2%   73.2%   0.2%   5.1%   4.2%
Tennessee 38.5%   75.1%   64.3%   51.0%   83.9%   74.5%   12.4%   8.8%   10.2%
Texas 40.6%   76.1%   64.5%   48.4%   82.1%   71.4%   7.7%   6.0%   6.9%
Utah   40.8%   72.8%   62.4%   40.9%   80.6%   67.7%   0.1%   7.8%   5.3%
Vermont 33.2%   76.9%   62.7%   41.4%   84.4%   71.1%   8.2%   7.5%   8.4%
Virginia 40.0%   78.4%   65.0%   50.8%   81.0%   71.3%   10.8%   2.6%   6.3%
Washington 36.1%   79.3%   64.9%   47.2%   81.1%   70.9%   11.0%   1.8%   6.0%
West Virginia 42.5%   79.8%   69.2%   50.4%   84.7%   75.6%   7.8%   4.9%   6.4%
Wisconsin 35.5%   78.2%   64.6%   46.7%   83.8%   73.1%   11.2%   5.6%   8.4%
Wyoming 42.4%   77.7%   65.6%   45.7%   81.4%   71.4%   3.3%   3.7%   5.8%
Puerto Rico 56.0%   70.8%   66.4%   55.1%   81.4%   74.0%   -0.9%   10.6%   7.7%
                                     
All states                                  
  Median 43.0%   77.8%   66.1%   49.1%   84.9%   74.1%   5.0%   7.1%   6.8%
  Max 56.0%   86.5%   73.0%   63.9%   91.4%   80.7%   16.9%   17.0%   15.7%
  Min 31.5%   63.4%   57.5%   36.0%   77.2%   65.1%   -7.3%   1.2%   2.0%
                                     


Source: CDC, Behavioral Risk Factor Surveillance Survey, 1997 and 2000.