Analysis of Geographic Accessibility of Breast, Lung, and Colorectal Cancer Screening Centers Among American Indian and Alaskan Native Tribes

Miguel A Peña; Anirudh Sudarshan; Claudia M Muns; Anand K Narayan; Carlos González; Jordan Neil; Dorothy A Rhoades; Mark P Doescher; Efrén J Flores

doi:10.1016/j.jacr.2023.04.007

Analysis of Geographic Accessibility of Breast, Lung, and Colorectal Cancer Screening Centers Among American Indian and Alaskan Native Tribes

J Am Coll Radiol. 2023 Jul;20(7):642-651. doi: 10.1016/j.jacr.2023.04.007. Epub 2023 May 23.

Authors

Miguel A Peña¹, Anirudh Sudarshan², Claudia M Muns³, Anand K Narayan⁴, Carlos González⁵, Jordan Neil⁶, Dorothy A Rhoades⁷, Mark P Doescher⁸, Efrén J Flores⁹

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Kennedy School of Government, Cambridge, Massachusetts.
² Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; The University of Texas at Austin, Austin, Texas.
³ School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
⁴ Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.
⁵ School of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico.
⁶ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
⁷ Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
⁸ Department of Family and Preventive Medicine, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma; Associate Director, Community Outreach and Engagement, Stephenson Cancer Center, Oklahoma City, Oklahoma.
⁹ Mass General Brigham Radiology Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ejflores@mgh.harvard.edu.

PMID: 37230232
DOI: 10.1016/j.jacr.2023.04.007

Abstract

Purpose: To evaluate geographic accessibility of ACR mammographic screening (MS), lung cancer screening (LCS), and CT colorectal cancer screening (CTCS) centers among US federally recognized American Indian and Alaskan Native (AI/AN) tribes.

Methods: Distances from AI/AN tribes' ZIP codes to their closest ACR-accredited LCS and CTCS centers were recorded using tools from the ACR website. The FDA's database was used for MS. Persistent adult poverty (PPC-A), persistent child poverty (PPC-C), and rurality indexes (rural-urban continuum codes) were from the US Department of Agriculture. Logistic and linear regression analyses were used to assess distances to screening centers and relationships among rurality, PPC-A, and PPC-C.

Results: Five hundred ninety-four federally recognized AI/AN tribes met the inclusion criteria. Among all closest MS, LCS, or CTCS center to AI/AN tribes, 77.8% (1,387 of 1,782) were located within 200 miles, with a mean distance of 53.6 ± 53.0 miles. Most tribes (93.6% [557 of 594]) had MS centers within 200 miles, 76.4% (454 of 594) had LCS centers within 200 miles, and 63.5% (376 of 594) had CTCS centers within 200 miles. Counties with PPC-A (odds ratio [OR], 0.47; P < .001) and PPC-C (OR, 0.19; P < .001) were significantly associated with decreased odds of having a cancer screening center within 200 miles. PPC-C was associated with decreased likelihood of having an LCS center (OR, 0.24; P < .001) and an CTCS center (OR, 0.52; P < .001) within the same state as the tribe's location. No significant association was found between PPC-A and PPC-C and MS centers.

Conclusions: AI/AN tribes experience distance barriers to ACR-accredited screening centers, resulting in cancer screening deserts. Programs are needed to increase equity in screening access among AI/AN tribes.

Keywords: American Indian and Alaskan Native tribes; Health equity; breast; cancer screening; cancer screening desert; colorectal; lung.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

American Indian or Alaska Native*
Breast Neoplasms* / diagnostic imaging
Colorectal Neoplasms* / diagnostic imaging
Early Detection of Cancer
Health Facilities* / standards
Health Facilities* / supply & distribution
Health Services Accessibility*
Humans
Lung Neoplasms* / diagnostic imaging
United States

Abstract

Publication types

MeSH terms

Grants and funding