Access to diagnostic mammography in the San Francisco Bay Area

Background: It is important to assess access to diagnostic mammography because of the high likelihood of breast cancer among women who need diagnostic evaluation. We studied access to diagnostic mammography in the Greater San Francisco Bay Area. Methods: We identified facilities that provide diagnostic mammography in nine counties in Northern California. We tried to schedule a diagnostic mammogram for a 40-50-year-old simulated patient without health insurance who recently discovered a palpable breast mass. The study had three parts. First, the simulated patient called mammography facilities to schedule a mammogram without a physician's referral; second, she called mammography facilities to schedule a mammogram with a physician's referral; third, she called primary care facilities to schedule a physician's visit in order to obtain a diagnostic mammography referral. For each scenario, our simulated patient recorded the time from the phone call until the first available visit. Results: Overall, 86 mammography facilities were identified. Only 3 facilities were willing to schedule diagnostic mammography without a physician's referral. With a physician's referral, the median wait time for diagnostic mammography was 5 days (standard deviation [SD] 15 days.) The average wait time to schedule a primary care visit to evaluate the breast mass was longer than to schedule diagnostic mammography (mean wait time for a new primary care visit 38.5 days, SD 62.4 days.) Conclusions: Access to diagnostic mammography was good in the Greater SF Bay Area if a woman had a physician's referral. It was more difficult to schedule a primary care visit to assess a palpable breast mass than to schedule the diagnostic mammography. Difficultly accessing primary care physicians may contribute to delay in the diagnosis of breast cancer, and this might be particularly relevant for underserved patients who may be less likely to have a primary care provider.