ArticleCancer causes & control : CCC2026
Mammography screening in Tennessee: a tract-level spatial analysis of geographic and socioeconomic disparities.
Article in Cancer causes & control : CCC, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeDespite improvements in early detection, Tennessee ranks among the top ten states for breast cancer mortality among women. Mammography screening and early diagnosis are critical to reducing mortality, yet access and uptake vary widely across the State. We tested whether access to diagnostic services affected screening in the State.
methodsWe merged CDC PLACES estimates of screening among women aged 50-74 with geocoded FDA-certified mammography facilities to derive drive-time categories. Tract covariates included education, poverty, insurance, race/ethnicity, primary care provider density, urban/rural status, and Appalachian designation. We mapped hot/cold spots using Getis-Ord Gi* and fit four nested beta-regression models: geography only, socioeconomic only, combined, and combined plus log-provider density.
resultsMedian screening prevalence was 74.8%. Hotspots clustered around Memphis, Nashville, and Knoxville; cold spots in Central Appalachian and western floodplain tracts. Geography explained ~ 23% of between-tract variation (pseudo-R
conclusionUrbanicity and education were the primary drivers of mammography screening disparities in Tennessee. To improve early diagnosis and outcomes, interventions should prioritize educational outreach, poverty reduction, insurance expansion, and improved geographic access, via mobile units or telehealth, targeting remote cold-spot tracts.
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