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An Assessment of the Quality of Mammography Care at Facilities Treating Medically Vulnerable Populations

Goldman, L Elizabeth MD, MCR*; Haneuse, Sebastien J.-P. A. PhD†‡; Miglioretti, Diana L. PhD†‡; Kerlikowske, Karla MD§¶; Buist, Diana S. M. PhD†; Yankaskas, Bonnie PhD∥; Smith-Bindman, Rebecca MD**§; for the National Cancer Institute Sponsored Breast Cancer Surveillance Consortium

doi: 10.1097/MLR.0b013e3181789329
Original Article

Background: Women in medically vulnerable populations, including racial and ethnic minorities, socioeconomically disadvantaged, and residents of rural areas, experience higher breast cancer mortality than do others. Whether mammography facilities that treat vulnerable women demonstrate lower quality of care than other facilities is unknown.

Objectives: To assess the quality of mammography women receive at facilities characterized as serving a high proportion of medically vulnerable populations.

Research Design: We prospectively collected self-reported breast cancer risk factor information, mammography interpretations, and cancer outcomes on 1,579,929 screening mammography examinations from 750,857 women, aged 40–80 years, attending any of 151 facilities in the Breast Cancer Surveillance Consortium between 1998 and 2004. To classify facilities as serving medically vulnerable populations, we used 4 criteria: educational attainment, racial/ethnic minority, household income, and rural/urban residence.

Results: After adjustment for patient-level factors known to affect mammography accuracy, facilities serving vulnerable populations had significantly higher mammography specificity than did other facilities: ie, those serving a higher proportion of women who were minorities [odds ratio (OR): 1.32; 95% confidence interval (CI): 1.01–1.73], living in rural areas (1.45; 1.15–1.73), and with lower household income (1.33; 1.05–1.68). We observed no statistically significant differences between facilities in mammography sensitivity.

Conclusions: Facilities serving high proportions of vulnerable populations provide screening mammography with equal or better quality (as reflected in higher specificity with no corresponding decrease in sensitivity) than other facilities. Further research is needed to understand the mechanisms underlying these findings.

From the *Department of Medicine, University of California, San Francisco, California; †Group Health Center for Health Studies, Seattle, Washington; ‡Department of Biostatistics, University of Washington, Seattle, Washington; §Department of Epidemiology and Biostatistics, University of California, San Francisco, California; ¶General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, California; and ∥Department of Radiology, University of North Carolina Chapel Hill, North Carolina; and **Department of Radiology, University of California, San Francisco, California.

This work was supported by the funds from National Cancer Institute under Breast Cancer Surveillance Consortium cooperative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, and U01CA70040).

A list of the BCSC investigators and procedures for requesting BCSC data for research are provided at:

Reprints: L. Elizabeth Goldman, MD, Division of General Medicine, University of California–San Francisco, 533 Parnassus Ave, Box 0131, San Francisco, CA 94143. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.