1 Department of Radiology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Charleston, SC 29425.
AJR Am J Roentgenol. 2017 Dec;209(6):1426-1429. doi: 10.2214/AJR.16.17670. Epub 2017 Sep 5.
Mobile mammography units have increasingly been used to address patient health care disparities; however, there are limited data comparing mobile units to stationary sites. This study aims to evaluate the characteristics of women who underwent mammography screening in a mobile unit versus those who underwent mammography screening at a cancer center.
In this retrospective study, we analyzed all screening mammography examinations performed in a mobile unit in 2014 (n = 1433 examinations). For comparison, we randomized and reviewed an equivalent number of screening mammography examinations performed at our cancer center in 2014 (n = 1434 examinations). BI-RADS assessment, adherence to follow-up, biopsies performed, cancer detection rate, and sociodemographic variables were recorded. An independent-samples t test was conducted to identify potential differences in age between cancer center patients and mobile unit patients. Chi-square analyses were used to test for associations between location and factors such as health insurance, race, marital status, geographic area, adherence to screening guidelines, recall rate, adherence to follow-up, and cancer detection rates.
Patients visiting our cancer center (mean = 57.74 years; SD = 10.55) were significantly older than those visiting the mobile unit (mean = 52.58 years; SD = 8.19; p < 0.001). There was a significant association between location and health insurance status (χ = 610.92; p < 0.001) with more uninsured patients undergoing screening in the mobile van (cancer center = 3.70%, mobile unit = 38.73%). There was a significant association between screening location and patient race (χ = 118.75, p < 0.001), with more white patients being screened at the cancer center (cancer center = 47.28%, mobile unit = 33.30%), more black patients being screened in the mobile van (cancer center = 49.30%, mobile unit = 54.15%), and more Hispanic patients being screened in the mobile van (cancer center = 1.05%, mobile unit = 6.77%). There was a significant association between location and patient marital status (χ = 135.61, p < 0.001), with more married patients screened at the cancer center (cancer center = 49.16%, mobile unit = 38.31%), more single patients screened in the mobile van (cancer center = 25.17%, mobile unit = 34.47%), and more widowed patients being screened at the cancer center (cancer center = 8.09%, mobile unit = 4.47%). There was a significant association between location and geographic area (χ = 33.33, p < 0.001), with both locations reaching more urban than rural patients (cancer center = 79.99%, mobile unit = 70.62%). There was a significant association between location and adherence to screening guidelines (χ = 179.60, p < 0.001), with patients screened at the cancer center being more compliant (cancer center = 56.90%, mobile unit = 34.47%). Finally, there was a significant association between location and recall rate (χ = 4.06, p < 0.001). The cancer center had a lower recall rate (13.32%) than the mobile van (15.98%). Of those patients with BI-RADS 0, there was a significant association between location and adherence to follow-up (χ = 22.75, p < 0.001) with patients using the mobile unit less likely to return for additional imaging (cancer center = 2.65%, mobile unit = 17.03%).
Significant differences were found among patients visiting the cancer center versus the mobile mammography van. The cancer center's population is older and more adherent to guidelines, whereas the mobile mammography population exhibited greater racial and marital diversity, higher recall rate, and lack of adherence to follow-up recommendations. By identifying these characteristics, we can develop programs and materials that meet these populations' needs and behaviors, ultimately increasing mammography screening and follow-up rates among underserved populations.
目的：移动乳房 X 光检查车越来越多地用于解决患者的医疗保健差异问题；然而，将移动单位与固定站点进行比较的数据有限。本研究旨在评估在移动单位接受乳房 X 光筛查的女性与在癌症中心接受乳房 X 光筛查的女性的特征。
材料和方法：在这项回顾性研究中，我们分析了 2014 年在移动单位进行的所有筛查性乳房 X 光检查（n = 1433 次检查）。为了比较，我们随机选择了 2014 年在我们癌症中心进行的相同数量的筛查性乳房 X 光检查（n = 1434 次检查）。BI-RADS 评估、随访依从性、活检、癌症检出率和社会人口统计学变量均被记录。采用独立样本 t 检验比较癌症中心患者和移动单位患者的年龄差异。采用卡方分析检验位置与健康保险、种族、婚姻状况、地理区域、筛查指南依从性、召回率、随访依从性和癌症检出率等因素之间的关联。
结果：在癌症中心就诊的患者（平均年龄 = 57.74 岁；标准差 = 10.55 岁）明显比在移动单位就诊的患者（平均年龄 = 52.58 岁；标准差 = 8.19 岁；p < 0.001）年龄更大。位置与健康保险状况之间存在显著关联（χ² = 610.92；p < 0.001），移动车筛查的未参保患者比例更高（癌症中心 = 3.70%，移动单位 = 38.73%）。筛查地点与患者种族之间存在显著关联（χ² = 118.75，p < 0.001），癌症中心的白人患者比例更高（癌症中心 = 47.28%，移动单位 = 33.30%），移动车筛查的黑人患者比例更高（癌症中心 = 49.30%，移动单位 = 54.15%），移动车筛查的西班牙裔患者比例更高（癌症中心 = 1.05%，移动单位 = 6.77%）。位置与患者婚姻状况之间存在显著关联（χ² = 135.61，p < 0.001），癌症中心的已婚患者比例更高（癌症中心 = 49.16%，移动单位 = 38.31%），移动车筛查的单身患者比例更高（癌症中心 = 25.17%，移动单位 = 34.47%），癌症中心的丧偶患者比例更高（癌症中心 = 8.09%，移动单位 = 4.47%）。位置与地理区域之间存在显著关联（χ² = 33.33，p < 0.001），两个地点都有更多的城市患者（癌症中心 = 79.99%，移动单位 = 70.62%）。位置与筛查指南依从性之间存在显著关联（χ² = 179.60，p < 0.001），癌症中心的患者更符合（癌症中心 = 56.90%，移动单位 = 34.47%）。最后，位置与召回率之间存在显著关联（χ² = 4.06，p < 0.001）。癌症中心的召回率（13.32%）低于移动车（15.98%）。在 BI-RADS 0 患者中，位置与随访依从性之间存在显著关联（χ² = 22.75，p < 0.001），使用移动单位的患者更不可能返回进行额外的影像学检查（癌症中心 = 2.65%，移动单位 = 17.03%）。
结论：在癌症中心就诊的患者与移动乳房 X 光检查车就诊的患者之间存在显著差异。癌症中心的患者年龄更大，更符合指南，而移动乳房 X 光检查车的患者则表现出更大的种族和婚姻多样性、更高的召回率和缺乏对随访建议的依从性。通过识别这些特征，我们可以制定满足这些人群需求和行为的计划和材料，最终提高服务不足人群的乳房 X 光筛查和随访率。
