{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:02:27Z","timestamp":1784707347191,"version":"3.55.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Cancer Causes Control"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Despite 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We merged CDC PLACES estimates of screening among women aged 50\u201374 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median screening prevalence was 74.8%. Hotspots clustered around Memphis, Nashville, and Knoxville; cold spots in Central Appalachian and western floodplain tracts. Geography explained\u2009~\u200923% of between-tract variation (pseudo-\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.238); socioeconomic covariates\u2009~\u200961% (0.607). In combined models, drive-time and Appalachian effects attenuated. Urban tracts screened 0.72 percentage points (pp) higher than rural, and each 1-pp rise in adults without a high-school diploma predicted\u2009\u2212\u20090.13\u00a0pp.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Urbanicity 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10552-026-02190-9","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:16:54Z","timestamp":1780553814000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mammography screening in Tennessee: a tract-level spatial analysis of geographic and socioeconomic disparities"],"prefix":"10.1007","volume":"37","author":[{"given":"Sima","family":"Namin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Wall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Eric","family":"Heidel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashton","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Allen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Ferris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"2190_CR1","unstructured":"American Cancer Society (2024) Breast Cancer Facts & Figures 2024\u20132025 [Internet]. Atlanta. Available from https:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/breast-cancer-facts-and-figures\/2024\/breast-cancer-facts-and-figures-2024.pdf"},{"key":"2190_CR2","unstructured":"National Cancer Institute (2025) Female breast cancer: cancer stat facts [Internet]. [cited 2025 May 9]. Available from https:\/\/seer.cancer.gov\/statfacts\/html\/breast.html"},{"key":"2190_CR3","unstructured":"American Cancer Society (2025) ACS breast cancer screening guidelines [Internet]. [cited 2025 Jul 23]. Available from https:\/\/www.cancer.org\/cancer\/types\/breast-cancer\/screening-tests-and-early-detection\/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"},{"key":"2190_CR4","unstructured":"National Comprehensive Cancer Network (NCCN) (2025) Breast cancer screening and diagnosis [Internet]. Available from https:\/\/www.nccn.org\/patients\/guidelines\/content\/PDF\/breastcancerscreening-patient.pdf"},{"key":"2190_CR5","unstructured":"Gibson S (2024) Navigating updated breast imaging guidelines: balancing early detection with radiation risks [Internet]. [cited 2025 Jul 23]. Available from https:\/\/www.acr.org\/News-and-Publications\/Navigating-Breast-Imaging-Guidelines"},{"key":"2190_CR6","unstructured":"National Center for Health Statistics. (2019) FastStats - Mammography [Internet]. Centers Dis. Control Prev. [cited 2025 Jul 29]. Available from https:\/\/www.cdc.gov\/nchs\/fastats\/mammography.htm"},{"key":"2190_CR7","doi-asserted-by":"publisher","first-page":"pkae113","DOI":"10.1093\/jncics\/pkae113","volume":"8","author":"GA Benavidez","year":"2024","unstructured":"Benavidez GA, Sedani AE, Felder TM, Asare M, Rogers CR (2024) Rural-urban disparities and trends in cancer screening: an analysis of Behavioral Risk Factor Surveillance System data (2018\u20132022). JNCI Cancer Spectr 8:pkae113","journal-title":"JNCI Cancer Spectr"},{"key":"2190_CR8","unstructured":"Tennessee Department of Health (2023) 2015\u20132019 Cancer in Tennessee [Internet]. Available from https:\/\/www.tn.gov\/content\/dam\/tn\/health\/program-areas\/cancer-registry\/2015-2019-Annual-Report.pdf"},{"key":"2190_CR9","unstructured":"Tennessee Department of Health. Breast Cancer Learning Community [Internet]. [cited 2025 May 15]. Available from: https:\/\/legacy.astho.org\/Prevention\/Chronic-Disease\/Breast-Cancer-Disparities\/Learning-Community\/Tennessee-One-Pager-Summary\/"},{"key":"2190_CR10","unstructured":"The Centers for Disease Control and Prevention (CDC) (2025) About the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) [Internet]. [cited 2025 Jul 29]. Available from https:\/\/www.cdc.gov\/breast-cervical-cancer-screening\/about\/index.html"},{"key":"2190_CR11","unstructured":"Tennessee Department of Health (2025) Tennessee Breast and Cervical Screening Program (TBCSP) [Internet]. [cited 2025 Jul 29]. Available from https:\/\/www.tn.gov\/health\/health-program-areas\/fhw\/tbcsp\/about-tbcsp.html"},{"key":"2190_CR12","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1634\/theoncologist.2015-0110","volume":"20","author":"M Ambroggi","year":"2015","unstructured":"Ambroggi M, Biasini C, Del Giovane C, Fornari F, Cavanna L (2015) Distance as a barrier to cancer diagnosis and treatment: review of the literature. Oncologist 20:1378","journal-title":"Oncologist"},{"key":"2190_CR13","first-page":"683","volume":"27","author":"JL Moss","year":"2017","unstructured":"Moss JL, Liu B, Feuer EJ (2017) Urban\/Rural differences in breast and cervical cancer incidence: the mediating roles of socioeconomic status and provider density. Women\u2019s Heal 27:683\u201391","journal-title":"Women\u2019s Heal"},{"key":"2190_CR14","doi-asserted-by":"publisher","first-page":"E37","DOI":"10.5888\/pcd18.200315","volume":"18","author":"GA Benavidez","year":"2021","unstructured":"Benavidez GA, Zgodic A, Zahnd WE, Eberth JM (2021) Disparities in meeting USPSTF breast, cervical, and colorectal cancer screening guidelines among women in the united states. Prev Chronic Dis 18:E37","journal-title":"Prev Chronic Dis"},{"key":"2190_CR15","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/00333549231155876","volume":"139","author":"DH Howard","year":"2024","unstructured":"Howard DH, Tangka FKL, Miller J, Sabatino SA (2024) Variation in state-level mammography use, 2012 and 2020. Public Health Rep 139:59\u201365","journal-title":"Public Health Rep"},{"key":"2190_CR16","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/j.whi.2018.06.001","volume":"28","author":"W Gathirua-Mwangi","year":"2018","unstructured":"Gathirua-Mwangi W, Cohee A, Tarver WL, Marley A, Biederman E, Stump T et al (2018) factors associated with adherence to mammography screening among insured women differ by income levels. Women\u2019s Heal Issues 28:462\u20139","journal-title":"Women\u2019s Heal Issues"},{"key":"2190_CR17","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1089\/jwh.2016.5830","volume":"26","author":"J Barry","year":"2017","unstructured":"Barry J (2017) The relationship between the supply of primary care physicians and measures of breast health service use. J Women\u2019s Heal 26:511","journal-title":"J Women\u2019s Heal"},{"key":"2190_CR18","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1186\/s12905-021-01274-9","volume":"21","author":"B Salmeron","year":"2021","unstructured":"Salmeron B, Mamudu L, Liu X, Whiteside M, Williams F (2021) Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis. BMC Womens Health 21:186","journal-title":"BMC Womens Health"},{"key":"2190_CR19","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1097\/MLR.0b013e31817a835d","volume":"46","author":"RM Andersen","year":"2008","unstructured":"Andersen RM (2008) National health surveys and the behavioral model of health services use. Med Care 46:647\u201353","journal-title":"Med Care"},{"key":"2190_CR20","unstructured":"U.S. Food & Drug Administration (2025) Mammography Facilities [Internet]. [cited 2025 Jul 2]. Available from: https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfmqsa\/mqsa.cfm?id=8920"},{"key":"2190_CR21","unstructured":"Centers for Disease Control and Prevention (2024) PLACES: Local Data for Better Health [Internet]. [cited 2025 Jul 9]. Available from: https:\/\/data.cdc.gov\/500-Cities-Places\/PLACES-Local-Data-for-Better-Health-Census-Tract-D\/em5e-5hvn\/about_data"},{"key":"2190_CR22","unstructured":"United States Census Bureau (2025) American Community Survey 5-Year Data (2009-2023) [Internet]. [cited 2025 Jul 2]. Available from: https:\/\/www.census.gov\/data\/developers\/data-sets\/acs-5year.html"},{"key":"2190_CR23","unstructured":"Centers for Medicare & Medicaid Services (2025) National Provider Identifier (NPI) Files [Internet]. [cited 2025 Jul 30]. Available from: https:\/\/download.cms.gov\/nppes\/NPI_Files.html"},{"key":"2190_CR24","unstructured":"Appalachian Regional Commission (2021) Appalachia Envisioned: ARC Strategic Plan Fiscal Years 2022\u20132026 [Internet]. Available from: https:\/\/www.arc.gov\/wp-content\/uploads\/2022\/01\/Appalachia-Envisioned-ARC-Strategic-Plan-FY-2022-2026.pdf"},{"key":"2190_CR25","unstructured":"U.S. Department of Agriculture (USDA) Economic Research Service (2025) Rural-Urban Commuting Area Codes [Internet]. [cited 2025 Aug 5]. Available from: https:\/\/www.ers.usda.gov\/data-products\/rural-urban-commuting-area-codes\/overview"},{"key":"#cr-split#-2190_CR26.1","unstructured":"Cambon J, Hernang\u00f3mez D, Belanger C, Possenriede D (2025) Geocoding Made Easy [R package tidygeocoder version 1.0.6] [Internet]. CRAN Contrib. Packag. Comprehensive R Archive Network (CRAN)"},{"key":"#cr-split#-2190_CR26.2","unstructured":"[cited 2025 Jul 9]. Available from: https:\/\/cran.r-project.org\/package=tidygeocoder"},{"key":"2190_CR27","first-page":"3","volume":"62","author":"S Mazzoni","year":"2017","unstructured":"Mazzoni S, Brewer S, Durfee J, Pyrzanowski J, Barnard J, Dempsey A et al (2017) Patient perspectives of obstetrician-gynecologists as primary care providers. J Reprod Med 62:3\u20138","journal-title":"J Reprod Med"},{"key":"#cr-split#-2190_CR28.1","unstructured":"GIScience Research Group (2023) ORS Tools QGIS plugin [Internet]. Heidelberg: University of Heidelberg"},{"key":"#cr-split#-2190_CR28.2","unstructured":"[cited 2025 Jul 29]. Available from https:\/\/plugins.qgis.org\/plugins\/ORStools\/"},{"key":"2190_CR29","unstructured":"QGIS Development Team (2025) QGIS Geographic Information System (Version 3.42) [Internet]. Open Source Geospatial Found. Proj [cited 2025 Jul 29]. Available from https:\/\/qgis.org\/"},{"key":"2190_CR30","unstructured":"Wickham H (2016) ggplot2: Elegant Graphics for Data Analysis [Internet]. J R Stat Soc Ser A Stat Soc [cited 2025 Aug 27]. 245\u20136. Available from https:\/\/ggplot2.tidyverse.org."},{"key":"2190_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v034.i02","volume":"34","author":"F Cribari-Neto","year":"2010","unstructured":"Cribari-Neto F, Zeileis A (2010) Beta regression in R. J Stat Softw 34:1\u201324","journal-title":"J Stat Softw"},{"key":"2190_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v069.i01","volume":"69","author":"RV Lenth","year":"2016","unstructured":"Lenth RV (2016) Least-squares means: the r package lsmeans. J Stat Softw 69:1\u201333","journal-title":"J Stat Softw"},{"key":"2190_CR33","unstructured":"The Centers for Disease Control and Prevention (CDC) (2022) Social Vulnerability Index (SVI) Interactive Map [Internet]. [cited 2025 Aug 29]. Available from https:\/\/www.atsdr.cdc.gov\/place-health\/php\/svi\/svi-interactive-map.html"},{"key":"2190_CR34","unstructured":"American Association for Cancer Research. AACR Cancer Disparities Progress Report 2024 [Internet]. 2024 [cited 2025 Aug 29]. Available from: https:\/\/cancerprogressreport.aacr.org\/disparities\/"}],"container-title":["Cancer Causes &amp; Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10552-026-02190-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10552-026-02190-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10552-026-02190-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T07:24:41Z","timestamp":1784705081000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10552-026-02190-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":36,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["2190"],"URL":"https:\/\/doi.org\/10.1007\/s10552-026-02190-9","relation":{},"ISSN":["0957-5243","1573-7225"],"issn-type":[{"value":"0957-5243","type":"print"},{"value":"1573-7225","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]},"assertion":[{"value":"24 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was exempt from Institutional Review Board of College of Medicine-Knoxville.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"105"}}