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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

 CurrentlyOperatingOperatingOperatingOperatingOperating
StateOperating1/1/011/1/001/1/9919971994
            
Alabama159 161 157 151 161 159
Alaska33 33 33 32 30 29
Arizona151 157 157 155 163 161
Arkansas113 109 105 101 110 109
California794 825 828 833 959 1091
Colorado115 116 112 112 117 123
Connecticut158 162 166 168 182 180
Delaware27 27 26 26 27 28
District of Columbia24 24 25 26 32 34
Florida503 524 506 488 539 563
Georgia268 268 270 269 290 289
Hawaii41 42 42 41 44 43
Idaho48 48 45 43 44 41
Illinois424 441 435 420 443 438
Indiana231 231 230 219 234 227
Iowa149 147 148 143 142 142
Kansas136 137 137 123 137 144
Kentucky174 173 175 170 165 170
Louisiana170 173 164 151 163 162
Maine63 62 57 55 57 56
Maryland157 156 159 165 195 198
Massachusetts205 205 209 218 231 224
Michigan339 344 341 350 356 369
Minnesota210 212 206 197 198 190
Mississippi106 102 98 100 99 101
Missouri187 192 199 194 206 213
Montana50 48 46 45 52 50
Nebraska93 92 90 88 88 83
Nevada61 57 54 51 62 62
New Hampshire49 49 48 44 47 49
New Jersey283 290 292 282 290 291
New Mexico48 48 50 48 56 57
New York710 712 709 688 748 763
North Carolina253 253 251 242 246 242
North Dakota42 44 41 38 40 42
Ohio445 455 456 455 467 451
Oklahoma105 106 106 103 111 114
Oregon98 98 99 99 102 104
Pennsylvania447 450 453 436 488 507
Rhode Island47 49 50 50 53 50
South Carolina126 132 134 119 121 121
South Dakota49 48 47 46 45 41
Tennessee211 212 210 196 200 195
Texas583 581 565 549 585 575
Utah47 48 48 43 48 49
Vermont19 19 18 18 18 17
Virginia214 216 221 213 226 239
Washington181 187 188 178 189 189
West Virginia85 87 85 83 90 87
Wisconsin253 252 240 225 236 233
Wyoming28 28 27 25 24 24
            
Total9,512 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%
Connecticut2.34 2.11 -9.8%
Delaware 1.65 1.51 -8.5%
District of Columbia2.49 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%
Massachusetts1.62 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 Hampshire1.86 1.74 -6.6%
New Jersey 1.53 1.46 -4.3%
New Mexico1.55 1.30 -16.3%
New York 1.77 1.61 -8.9%
North Carolina1.46 1.39 -4.6%
North Dakota2.78 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%
Pennsylvania1.63 1.46 -10.7%
Rhode Island2.26 2.08 -7.8%
South Carolina1.42 1.41 -0.6%
South Dakota2.78 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%
Washington1.57 1.45 -7.7%
West Virginia1.95 1.78 -8.5%
Wisconsin 2.03 1.94 -4.7%
Wyoming 2.31 2.40 4.1%
       
Median, all states1.73 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  19972000[a] Change 1997-2000
             
Alaska 71,329 77,561 8.7%  443488 10.1%
Alabama 656,797 685,987 4.4%  21,89320,787 -5.1%
Arizona 520,294 870,851 67.4%  3,1925,547 73.8%
Arkansas 289,701 403,036 39.1%  2,6343,767 43.0%
California 4,219,730 4,894,071 16.0%  4,4005,921 34.6%
Colorado 513,556 603,597 17.5%  4,3895,295 20.6%
Connecticut523,607 648,065 23.8%  2,8773,952 37.4%
District of Columbia89,561 100,007 11.7%  3,3173,774 13.8%
Delaware 120,393 151,500 25.8%  3,7626,184 64.4%
Florida 2,654,245 2,947,370 11.0%  4,9245,723 16.2%
Georgia 1,084,512 1,221,901 12.7%  3,7404,542 21.5%
Hawaii 179,940 199,975 11.1%  4,0904,761 16.4%
Iowa 371,219 473,081 27.4%  8,43710,174 20.6%
Idaho 128,210 151,677 18.3%  289346 19.7%
Illinois 1,661,097 2,014,576 21.3%  7,0998,740 23.1%
Indiana 780,326 947,962 21.5%  5,4956,427 17.0%
Kansas 360,660 422,202 17.1%  2,6333,082 17.1%
Kentucky 563,798 671,122 19.0%  3,4173,857 12.9%
Louisiana 623,675 736,965 18.2%  3,8264,374 14.3%
Massachusetts1,030,159 1,210,546 17.5%  18,07320,345 12.6%
Maryland 850,915 942,654 10.8%  4,3645,985 37.2%
Maine 190,348 218,709 14.9%  8241,057 28.2%
Michigan 1,490,070 1,775,562 19.2%  4,1865,184 23.9%
Minnesota 606,215 737,089 21.6%  3,0623,527 15.2%
Missouri 712,248 901,631 26.6%  7,1949,016 25.3%
Mississippi 329,960 376,079 14.0%  1,6021,924 20.1%
Montana 111,030 137,630 24.0%  2,1352,928 37.1%
North Carolina1,123,628 1,371,983 22.1%  12,76915,077 18.1%
North Dakota87,497 95,217 8.8%  1,4111,716 21.6%
Nebraska 205,249 268,880 31.0%  4,3675,544 27.0%
New Hampshire171,582 201,095 17.2%  592691 16.8%
New Jersey 1,262,470 1,514,622 20.0%  22,54430,911 37.1%
New Mexico202,157 248,780 23.1%  270350 29.6%
Nevada 218,622 292,841 33.9%  8891,162 30.8%
New York 3,006,550 3,384,130 12.6%  75,16479,627 5.9%
Ohio 1,644,999 1,963,561 19.4%  3,5224,311 22.4%
Oklahoma 410,138 496,664 21.1%  3,6954,686 26.8%
Oregon 467,291 536,200 14.7%  4,5815,444 18.8%
Pennsylvania1,870,454 2,159,221 15.4%  3,8334,782 24.8%
Rhode Island161,944 200,637 23.9%  3,0564,053 32.7%
South Carolina474,666 671,933 41.6%  3,9235,052 28.8%
South Dakota99,862 113,612 13.8%  2,2192,392 7.8%
Tennessee 822,266 942,073 14.6%  4,1114,465 8.6%
Texas 2,306,786 2,901,529 25.8%  3,9435,064 28.4%
Utah 198,028 235,049 18.7%  4,1264,897 18.7%
Virginia 920,460 1,115,348 21.2%  51,13760,289 17.9%
Vermont 74,411 93,402 25.5%  329427 29.8%
Washington722,013 850,678 17.8%  3,8204,537 18.8%
Wisconsin 650,724 832,968 28.0%  7,2309,686 34.0%
West Virginia257,001 323,929 26.0%  1,0891,317 20.9%
Wyoming 58,501 63,733 8.9%  2,4382,318 -4.9%
             
Median, all states513,556 648,065 19.0%  3,8204,686 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
State40 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
                  
Alabama35.7% 54.8% 49.3% 31.7% 61.2% 52.9% -4.0% 6.4% 3.6%
Alaska28.4% 66.4% 50.2% 32.0% 66.8% 53.2% 3.7% 0.5% 3.1%
Arizona31.7% 44.1% 40.4% 45.9% 70.5% 63.4% 14.2% 26.4% 23.0%
Arkansas28.3% 41.4% 37.9% 34.4% 59.7% 53.1% 6.1% 18.3% 15.3%
California29.0% 60.1% 49.7% 30.0% 65.6% 54.1% 1.0% 5.5% 4.4%
Colorado33.5% 57.8% 49.3% 29.2% 63.9% 52.5% -4.2% 6.2% 3.1%
Connecticut32.7% 61.7% 52.9% 43.6% 74.6% 65.5% 10.9% 13.0% 12.6%
Delaware38.8% 64.6% 56.8% 41.9% 77.0% 66.8% 3.0% 12.5% 10.0%
District of Columbia33.4% 62.0% 53.2% 48.2% 65.1% 59.9% 14.8% 3.1% 6.8%
Florida33.4% 66.2% 57.7% 37.0% 68.4% 60.4% 3.6% 2.3% 2.6%
Georgia36.9% 58.6% 51.5% 34.1% 62.3% 53.4% -2.9% 3.8% 1.9%
Hawaii36.7% 62.7% 54.6% 41.6% 67.7% 60.0% 5.0% 4.9% 5.4%
Idaho19.2% 50.2% 40.6% 23.5% 54.4% 45.5% 4.3% 4.1% 4.8%
Illinois28.5% 57.6% 48.8% 40.8% 64.7% 57.6% 12.3% 7.0% 8.8%
Indiana35.2% 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%
Kansas33.7% 55.8% 49.2% 35.6% 63.6% 55.5% 1.9% 7.7% 6.3%
Kentucky32.9% 55.5% 48.8% 38.5% 64.3% 56.9% 5.5% 8.8% 8.1%
Louisiana32.2% 57.0% 49.3% 44.4% 66.2% 59.7% 12.2% 9.2% 10.4%
Maine26.5% 63.7% 52.5% 36.3% 69.9% 60.2% 9.8% 6.2% 7.7%
Maryland35.7% 69.8% 58.6% 39.0% 72.3% 61.8% 3.3% 2.6% 3.2%
Massachusetts39.1% 65.5% 57.4% 43.8% 73.6% 64.8% 4.6% 8.1% 7.4%
Michigan34.9% 63.3% 54.5% 42.7% 71.2% 62.9% 7.9% 8.0% 8.4%
Minnesota25.9% 57.3% 47.6% 37.8% 62.4% 55.1% 11.9% 5.1% 7.5%
Mississippi29.0% 48.0% 42.4% 28.0% 53.3% 46.0% -1.0% 5.2% 3.6%
Missouri25.0% 53.1% 45.1% 34.8% 63.1% 55.2% 9.7% 10.0% 10.1%
Montana29.3% 51.2% 44.5% 30.7% 64.6% 54.9% 1.4% 13.4% 10.4%
Nebraska26.9% 51.2% 44.1% 40.1% 61.6% 55.5% 13.2% 10.3% 11.3%
Nevada22.5% 55.0% 44.8% 28.6% 64.5% 53.5% 6.1% 9.5% 8.8%
New Hampshire37.0% 63.2% 54.7% 42.5% 67.3% 59.5% 5.5% 4.0% 4.9%
New Jersey37.1% 56.3% 50.5% 41.0% 67.6% 60.0% 4.0% 11.4% 9.5%
New Mexico28.5% 53.1% 45.1% 32.5% 62.1% 52.8% 4.0% 9.0% 7.7%
New York36.2% 63.2% 55.2% 40.8% 69.2% 61.0% 4.6% 6.0% 5.8%
North Carolina37.0% 58.2% 51.8% 36.4% 66.9% 58.0% -0.6% 8.6% 6.1%
North Dakota32.8% 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%
Oklahoma27.0% 47.4% 41.7% 34.5% 57.9% 51.4% 7.5% 10.4% 9.7%
Oregon26.1% 60.1% 49.7% 28.4% 65.9% 55.0% 2.3% 5.8% 5.3%
Pennsylvania37.3% 54.6% 49.9% 41.7% 64.3% 58.3% 4.4% 9.7% 8.4%
Rhode Island34.8% 63.6% 55.1% 44.7% 73.2% 65.1% 9.9% 9.6% 10.0%
South Carolina25.8% 51.4% 43.5% 36.1% 66.8% 57.9% 10.4% 15.5% 14.4%
South Dakota36.6% 55.2% 49.9% 37.1% 64.7% 57.1% 0.5% 9.5% 7.2%
Tennessee29.6% 58.9% 50.4% 36.5% 64.8% 56.7% 6.9% 5.9% 6.4%
Texas27.9% 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%
Vermont22.4% 56.2% 45.3% 31.7% 65.5% 55.2% 9.3% 9.3% 9.9%
Virginia28.8% 57.1% 47.4% 38.3% 63.3% 55.5% 9.5% 6.2% 8.1%
Washington25.3% 57.2% 46.8% 33.0% 60.5% 52.0% 7.6% 3.3% 5.2%
West Virginia28.1% 51.7% 45.4% 35.4% 63.6% 56.4% 7.3% 11.8% 11.0%
Wisconsin24.4% 54.4% 45.3% 34.3% 64.7% 55.9% 9.9% 10.3% 10.6%
Wyoming27.0% 52.8% 44.3% 26.6% 58.3% 48.6% -0.4% 5.6% 4.3%
                   
All States                 
 Median29.9% 57.0% 49.3% 36.3% 64.7% 56.1% 5.0% 8.0% 7.7%
 Maximum39.1% 69.8% 58.6% 48.2% 77.0% 66.8% 14.8% 26.4% 23.0%
 Minimum19.2% 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
VariablesChange 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, 19970.164
*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
State40 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
                  
Alabama46.3% 81.8% 70.2% 46.8% 86.4% 74.9% 0.6% 4.6% 4.8%
Alaska37.6% 81.2% 63.1% 40.5% 86.4% 67.4% 2.9% 5.2% 4.3%
Arizona49.8% 71.7% 65.0% 63.9% 86.9% 80.7% 14.1% 15.2% 15.7%
Arkansas47.3% 71.3% 64.5% 51.3% 85.1% 76.2% 4.0% 13.8% 11.7%
California44.1% 81.5% 69.7% 42.0% 85.4% 71.7% -2.0% 4.0% 2.0%
Colorado46.4% 78.4% 67.0% 39.1% 84.7% 69.8% -7.3% 6.3% 2.8%
Connecticut41.2% 82.5% 68.6% 50.7% 88.7% 77.5% 9.5% 6.2% 8.9%
Delaware49.9% 81.8% 72.2% 49.0% 91.4% 78.9% -0.9% 9.6% 6.7%
District of Columbia39.1% 72.9% 62.3% 55.4% 85.5% 75.2% 16.3% 12.6% 12.9%
Florida43.8% 82.5% 72.5% 52.9% 86.1% 78.2% 9.2% 3.6% 5.7%
Georgia43.5% 74.1% 63.2% 46.4% 81.1% 70.3% 2.9% 7.0% 7.1%
Hawaii48.5% 80.1% 70.8% 51.9% 87.3% 76.8% 3.4% 7.1% 6.0%
Idaho31.5% 75.6% 61.9% 36.0% 78.4% 66.3% 4.5% 2.8% 4.4%
Illinois39.7% 79.7% 67.0% 50.0% 84.7% 73.8% 10.3% 4.9% 6.8%
Indiana47.0% 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%
Kansas42.9% 75.6% 65.1% 48.2% 85.2% 74.3% 5.4% 9.6% 9.2%
Kentucky48.6% 83.8% 73.0% 54.5% 86.0% 77.3% 6.0% 2.2% 4.3%
Louisiana41.3% 77.9% 65.8% 57.4% 86.4% 77.4% 16.2% 8.5% 11.6%
Maine40.9% 78.9% 68.6% 49.2% 86.1% 75.7% 8.3% 7.2% 7.2%
Maryland43.1% 86.5% 71.9% 45.5% 87.7% 74.1% 2.4% 1.2% 2.2%
Massachusetts46.9% 83.7% 71.9% 53.7% 86.9% 77.3% 6.9% 3.1% 5.4%
Michigan50.4% 81.1% 72.0% 55.3% 87.5% 77.4% 5.0% 6.4% 5.3%
Minnesota37.1% 79.3% 66.8% 49.1% 84.2% 73.2% 12.0% 4.9% 6.4%
Mississippi43.5% 69.3% 61.4% 38.8% 77.2% 65.1% -4.7% 7.9% 3.7%
Missouri32.7% 77.2% 62.6% 46.8% 84.3% 73.3% 14.1% 7.1% 10.7%
Montana43.9% 72.7% 64.3% 40.6% 83.6% 72.0% -3.3% 10.9% 7.6%
Nebraska35.8% 75.6% 62.8% 52.7% 87.1% 76.6% 16.9% 11.6% 13.8%
Nevada37.8% 76.0% 64.6% 41.5% 84.3% 71.3% 3.7% 8.3% 6.7%
New Hampshire50.1% 82.9% 72.0% 54.3% 86.7% 76.9% 4.1% 3.9% 4.9%
New Jersey46.6% 79.0% 68.5% 52.8% 87.2% 77.1% 6.2% 8.2% 8.6%
New Mexico42.0% 76.0% 64.7% 44.1% 83.1% 70.8% 2.2% 7.1% 6.1%
New York44.6% 76.9% 67.2% 49.6% 86.2% 75.2% 5.0% 9.3% 8.0%
North Carolina48.6% 78.8% 69.5% 48.2% 83.6% 73.6% -0.4% 4.8% 4.1%
North Dakota45.6% 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%
Oklahoma41.2% 63.4% 57.5% 49.3% 80.4% 71.8% 8.1% 17.0% 14.3%
Oregon37.5% 77.8% 66.0% 42.3% 86.0% 73.9% 4.7% 8.2% 7.9%
Pennsylvania47.2% 79.3% 69.6% 51.9% 83.3% 74.2% 4.7% 4.0% 4.6%
Rhode Island46.2% 78.9% 69.3% 53.5% 87.5% 77.8% 7.3% 8.6% 8.5%
South Carolina36.6% 75.4% 63.3% 45.4% 84.7% 73.3% 8.8% 9.3% 10.0%
South Dakota49.6% 77.1% 69.0% 49.8% 82.2% 73.2% 0.2% 5.1% 4.2%
Tennessee38.5% 75.1% 64.3% 51.0% 83.9% 74.5% 12.4% 8.8% 10.2%
Texas40.6% 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%
Vermont33.2% 76.9% 62.7% 41.4% 84.4% 71.1% 8.2% 7.5% 8.4%
Virginia40.0% 78.4% 65.0% 50.8% 81.0% 71.3% 10.8% 2.6% 6.3%
Washington36.1% 79.3% 64.9% 47.2% 81.1% 70.9% 11.0% 1.8% 6.0%
West Virginia42.5% 79.8% 69.2% 50.4% 84.7% 75.6% 7.8% 4.9% 6.4%
Wisconsin35.5% 78.2% 64.6% 46.7% 83.8% 73.1% 11.2% 5.6% 8.4%
Wyoming42.4% 77.7% 65.6% 45.7% 81.4% 71.4% 3.3% 3.7% 5.8%
Puerto Rico56.0% 70.8% 66.4% 55.1% 81.4% 74.0% -0.9% 10.6% 7.7%
                   
All states                 
 Median43.0% 77.8% 66.1% 49.1% 84.9% 74.1% 5.0% 7.1% 6.8%
 Max56.0% 86.5% 73.0% 63.9% 91.4% 80.7% 16.9% 17.0% 15.7%
 Min31.5% 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.