Factors Facilitating Acceptable Mammography Services for Women with Disabilities



      Prior research has described general barriers to breast cancer screening for women with disabilities (WWD). We explored specific accommodations described as necessary by WWD who have accessed screening services, and the presence of such accommodations in community-based screening programs.


      We surveyed WWD in the Carolina Mammography Registry to determine what accommodations were needed when accessing breast screening services, and whether or not these needs were met. The sample of 1,348 WWD was identified through a survey of limitations, with a response rate of 45.5% (4,498/9,885). Of the 1,348 WWD eligible for the second survey, 739 responded for a response rate of 54.8%.


      The most frequently needed accommodations were an accessible changing area with a bench (60.0%), oral description of the procedure by the technologist (60.5%), and handicapped/accessible parking (27.6%). Handicapped parking was the need most likely to go unmet (3.1%).


      Most needs are being met by radiology facilities and staff, and the few needs going unmet are related to the physical/built environment. Overall, for WWD who are in screening, the mammography system seems to be more accessible than generally perceived.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. American Cancer Society. (2008). American Cancer Society Guidelines for the early detection of cancer. Retrieved July 9, 2009 from

      2. American Cancer Society. (2010). Cancer facts & figures 2010. Atlanta: American Cancer Society. Retrieved October 31, 2011 from

      3. American College of Radiology. (2008). ACR practice guideline for the performance of screening and diagnostic mammography. Practice Guidelines and Technical Standards Retrieved January 31, 2011, 2011, from

      4. Carolina Mammography Registry (CMR). (2011). CMR overview. Retrieved October 31, 2011 from

      5. Dillman, D., & Carley-Baxter, L. (2001). Structural determinants of mail survey response rates over a 12-year period, 1989–1999. Paper presented at the Proceedings of American Statistical Association Survey Methods Section, Alexandria, VA.

        • Dillman D.A.
        Mail and internet surveys: The tailored design method.
        Wiley, New York2000
        • Dillman D.A.
        • Clark J.R.
        • Sinclair M.A.
        How prenotice letters, stamped return envelopes, and reminder postcards affect mailback response rates for census questionnaires.
        Survey Methodology. 1995; 21: 7
        • Iezzoni L.
        Improving health care quality and safety for people with disabilities: An interview with Lisa Iezzoni. Interview by Steven Berman.
        Joint Commission Journal on Quality and Patient Safety. 2006; 32: 400-406
        • Iezzoni L.I.
        • Davis R.B.
        • Soukup J.
        • O'Day B.
        Satisfaction with quality and access to health care among people with disabling conditions.
        International Journal for Quality in Health Care. 2002; 14: 369-381
        • Iezzoni L.I.
        • McCarthy E.P.
        • Davis R.B.
        • Harris-David L.
        • O'Day B.
        Use of screening and preventive services among women with disabilities.
        American Journal of Medical Quality. 2001; 16: 135-144
        • Kroll T.
        • Jones G.C.
        • Kehn M.
        • Neri M.T.
        Barriers and strategies affecting the utilization of primary preventive services for people with physical disabilities: A qualitative inquiry.
        Health & Social Care in the Community. 2006; 14: 284-293
        • McCarthy E.P.
        • Ngo L.H.
        • Roetzheim R.G.
        • Chirikos T.N.
        • Li D.
        • Drews R.E.
        • et al.
        Disparities in breast cancer treatment and survival for women with disabilities.
        Annals of Internal Medicine. 2006; 145: 637-645
        • Morrison E.H.
        • George V.
        • Mosqueda L.
        Primary care for adults with physical disabilities: Perceptions from consumer and provider focus groups.
        Family Medicine. 2008; 40: 645-651
      6. National Cancer Institute. (2010, October 1). Screening mammography: Help with explaining benefits and potential harms. Retrieved October 31, 2011, from

      7. North Carolina State Center for Health Statistics. (2011). Behavioral Risk Factor Surveillance System (BRFSS) Calendar Year 2009 Results. Retrieved October 31, 2011 from

      8. North Carolina Office of Disability and Health and the State Center for Health Statistics. (2004). Health and disability in North Carolina, 2003: A joint report from the NC office on disability and health and the state center for health statistics. Raleigh, NC.

        • O'Neill S.C.
        • Bowling J.M.
        • Brewer N.T.
        • Lipkus I.M.
        • Skinner C.S.
        • Strigo T.S.
        • et al.
        Intentions to maintain adherence to mammography.
        Journal of Women’s Health (Larchmont). 2008; 17: 1133-1141
        • Roetzheim R.G.
        • Chirikos T.N.
        Breast cancer detection and outcomes in a disability beneficiary population.
        Journal of Health Care for the Poor and Underserved. 2002; 13: 461-476
        • Skinner C.S.
        • Champion V.L.
        • Gonin R.
        • Hanna M.
        Do perceived barriers and benefits vary by mammography stage? Psychology.
        Health & Medicine. 1997; 2: 10
        • Smeltzer S.C.
        • Sharts-Hopko N.C.
        • Ott B.B.
        • Zimmerman V.
        • Duffin J.
        Perspectives of women with disabilities on reaching those who are hard to reach.
        Journal of Neuroscience Nursing. 2007; 39: 163-171
      9. Susan G Komen for the Cure. (2008). Early detection and screening: General recommendations. Retrieved July 9, 2009, from

      10. U.S. Census Bureau. (2011). American fact finder. Retrieved October 31, 2011 from

      11. U.S. Centers for Disease Control and Prevention. (2010). Behavioral Risk Factor Surveillance System prevalence and trends data. Retrieved February 20, 2012 from

      12. U.S. Department of Health and Human Services. (2011). Healthy People 2020 topics and objectives: Disability and health. Retrieved October 31, 2011 from

      13. U.S. Department of Health and Human Services Office of Disability. (2005). Access to quality health services and disability: A companion to chapter 1 of Health People 2010. Retrieved November 10, 2008, 2008, from

      14. U.S. Department of Justice. (2010, November 17, 2010). 2010 ADA standards for accessible design. Retrieved June 2, 2011, from

        • U.S. Preventive Services Task Force
        Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.
        Annals of Internal Medicine. 2009; 151: 716W-726W
        • Yankaskas B.C.
        • Dickens P.
        • Bowling J.M.
        • Jarman M.P.
        • Luken K.
        • Salisbury K.
        • et al.
        Barriers to adherence to screening mammography among women with disabilities.
        American Journal of Public Health. 2009; 100: 947-953


      Molly P. Jarman, MPH, is a research specialist in the UNC-CH Department of Radiology. Her research focuses on use and performance of breast cancer screening services.


      J. Michael Bowling, PhD, is a Research Associate Professor of Health Behavior and Health Education, and an Adjunct Research Associate Professor of Biostatistics, UNC-CH. He has significant experience in questionnaire development and survey administration.


      Pamela Dickens, MPH, is the Women’s Health Coordinator for the North Carolina Office on Disability and Health. Her research interests include health care access and utilization, and health disparities for women with disabilities.


      Karen Luken, MSRA, is an investigator with the North Carolina Office on Disability and Health. Her research interests include accessibility and utilization of health care services for people with disabilities.


      Bonnie C. Yankaskas, PhD, is a Professor Emeritus in the Department of Radiology, UNC-CH, who created the Carolina Mammography Registry, and has published widely on breast cancer screening. Her areas of interest include screening performance, dissemination of emerging technologies, and disparities in cancer treatment and outcomes.