06 Breast Imaging Access and Geographic Inequality in Miami-Dade County: Implications for Diagnostic Delay and Stage at Presentation

Background

Breast imaging is essential for breast cancer screening, diagnosis, and treatment, facilitating early detection and improving survival. Despite its benefits, imaging disparities exist, driven partly by unequal access to mammography services; long travel distances reduce adherence and delay diagnosis. Miami-Dade County is a critical setting to examine these disparities due to its high income inequality and diverse, large population. This study integrates literature and population-level data to evaluate geographic inequality in Miami-Dade’s breast imaging access and its implications for diagnostic delay and stage at presentation.

Materials and Methods

A narrative review was conducted using Google Scholar and PubMed to identify peer-reviewed studies from 2000 to 2024, evaluating geographic disparities in breast imaging access, diagnostic delay, race/ethnicity, and socioeconomic status in breast cancer. Data on mammography facilities were obtained from the FDA Mammography Facility Database. Zip code–level data on women aged 40 years or older, race/ethnicity, and median household income were obtained from the US Census Bureau American Community Survey (2023 five-year estimates). Spearman correlation coefficients assessed associations between facility density and demographic variables. Geospatial visualization was performed using zip code–level mapping.

Results

Substantial geographic variation in mammography facility access was observed across Miami-Dade County. Across 77 zip codes, the population of women aged 40 years or older ranged from fewer than 3000 to more than 22,000 per zip code, yet facility distribution was highly uneven (Figure). Forty-nine zip codes contained no mammography facilities, yielding an access ratio of 0 facilities per 10,000 women. Many low-access zip codes serve large screening-eligible populations, including 33010, 33012, 33013, 33014, 33015, 33142, and 33147 (8000 to 22,000 women aged ≥40 years). A small cluster of zip codes in central and northeastern Miami-Dade exhibited the highest facility density. Many zip codes with zero facilities were concentrated in lower-income areas, including 33010 ($45,449) and 33012 ($45,818), and had higher proportions of Hispanic/Latino (>70%) and Black/African American (>10%-20%) residents. Zip codes with the highest facility density tended to be in wealthier areas, including Coral Gables (33146; $93,430) and Aventura (33180; $74,934). Correlation analysis demonstrated modest positive correlations between facility density and percent White (P = .28) and percent Asian residents (P = .24), and a modest negative correlation with percent Black residents (P = −.23).

Conclusion

Breast imaging access in Miami-Dade is unevenly distributed, with large, lower-income, and minority-serving zip codes frequently lacking local mammography facilities. These spatial inequities suggest that structural barriers may contribute to diagnostic delays and later-stage presentations, consistent with prior research. Geospatial analyses may inform interventions, including mobile mammography and strategic placement of breast imaging centers, improving screening access and reducing disparities in breast cancer outcomes.