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Racial disparities seen in care after abnormal mammograms
Despite subpopulations’ similar onsite access to diagnostics and biopsy, the use of those capabilities varied, a study shows
Despite similar availability of diagnostic technologies to women of different racial and ethnic groups, significant disparities were seen in who actually received same-day diagnostic services and biopsies after abnormal mammogram findings, new research shows. Even when breast-care facilities had the necessary technology and capabilities, minority groups were less likely than white women to receive diagnostic imaging on the same day as an abnormal screening result. Black women in particular were less likely to receive same-day biopsies, compared with white women.
The findings of a retrospective study are to be published Feb. 18 in the journal Radiology. The lead author is Dr. Marissa Lawson, assistant professor of radiology at the University of Washington School of Medicine. Dr. Christoph Lee, UW professor of radiology, was senior author.
“We’re looking at how the diagnostic workup process might contribute to the population disparities we see with breast-cancer outcomes,” Lawson said. “It was surprising to find similar availability (of technologies) across racial and ethnic groups. But we still saw big differences in who was getting those same-day services.”
The retrospective study spanned nearly 11 years, from January 2010 to December 2020. The data represented more than 1.1 million female patients ages 40-89 and more than 3.5 million screening mammograms. The patients were seen in six U.S. states at 136 screening facilities that, as members of the Breast Cancer Surveillance Consortium, make data available for study.
The screening results were from individuals who self-identified as Asian (10%), Black (13%), Hispanic/Latinx (6.5%), white (68%) and “All others” (2%).
With the multilevel analysis, the researchers hoped to shed light on how factors such as race and ethnicity, household income and neighborhood educational attainment affected access to, and use of, breast-cancer diagnostics.
In the study, they first identified which consortium facilities offered onsite access to both standard-care and advanced diagnostics and biopsy. They then measured patients’ access to these capabilities, discerned which screening mammograms yielded an abnormal result, and evaluated those patients’ receipt of diagnostic imaging and biopsy on the same day and within 90 days at facilities that had the technology and capability onsite.
The researchers adjusted for several potentially influential factors such as patient breast density, biopsy history, personal and family history of breast cancer.
Asian, Black and Hispanic/Latinx patients received fewer same-day diagnostic services after undergoing a screening mammography with abnormal results at facilities offering any diagnostic or biopsy services. Patients who lived in the lowest-income neighborhoods were 58% less likely to have same-day diagnostic evaluations than those living in the highest-income neighborhoods.
Notably, Lawson said, rural-resident patients were more likely to receive same-day diagnostic services than were urban residents.
Black patients and those who lived in a relatively lower median income were less likely than white patients to receive same-day biopsy at a capable facility. However, Hispanic/Latinx patients were more likely than white patients to receive same-day biopsy.
“Getting a screening mammogram is an anxiety-inducing experience for a lot of people, and most patients I encounter want their results as soon as possible,” Lawson said.
“If you're able to do a diagnostic workup on the same day, instead of making them wait to schedule a follow-up visit — which might create a headache with work or transportation — that’s better for the patient. And if treatment is advised based on imaging and biopsy, we should do all we can to shorten the time between screening and treatment (for those diagnosed with breast cancer).”
The authors acknowledged several limitations, including a study population that might not be nationally representative of women’s education and rural residency. Variables that might affect patients’ ability to take advantage to clinic services, such as employment, insurance status, transportation barriers and childcare needs, were not included in the analyses. It also is unknown whether individual patients declined the opportunity for same-day services or were not offered such services.
The study received funding from the National Cancer Institute (R01 CA266377,
P01 CA154292)
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Journal
Radiology
Method of Research
Literature review
Subject of Research
People
Article Title
Disparities in Standard-of-Care, Advanced, and Same-day Diagnostic Services Among Patients with Abnormal Screening Mammography
Article Publication Date
18-Feb-2025
Racial disparities seen in same-day breast diagnostic and biopsy services
Radiological Society of North America
OAK BROOK, Ill. – Different sociodemographic groups, especially racial and ethnic minorities, are less likely to receive timely breast cancer diagnostic services after an abnormal screening mammogram, according to a study published today in Radiology, a journal of the Radiological Society of North America (RSNA).
Routine yearly screening mammography is an important first step in the early diagnosis of breast cancer. When a screening mammogram comes back as abnormal, additional imaging and image-guided biopsy may be necessary to diagnose breast cancer.
When it is caught early enough, before symptoms are present, breast cancer can be easier to treat and significantly reduces a patient’s chance of dying of cancer. A delay in diagnosis can result in further progression of the disease and a poorer overall prognosis for the patient.
Receiving diagnostic services on the same day of an abnormal screening can aid in a timely cancer diagnosis. However, not all screening facilities offer additional diagnostic or same-day services. This means a potential delay in a cancer diagnosis for many patients.
Researchers from the University of Washington sought to identify if there is a link between sociodemographic factors and access to screening facilities with adequate diagnostic services.
“Many people are aware of the need to reduce disparities in the uptake of screening mammography. However, ensuring availability and receipt of quality diagnostic breast imaging is also necessary to diagnose breast cancer,” said study author Marissa B. Lawson, M.D., M.S., assistant professor of radiology at the University of Washington School of Medicine in Seattle. “Identifying and understanding the disparities in diagnostic breast imaging can facilitate the development of interventions that aim to close gaps in this care pathway and may ultimately improve breast cancer outcomes and patient satisfaction.”
For this retrospective study, Dr. Lawson and colleagues compiled data from six Breast Cancer Surveillance Consortium breast imaging registries.
The data included over 3.5 million screening mammograms that were conducted on 1.1 million women at a total of 136 facilities located throughout the U.S. Of the 1,123,177 women, approximately 10% were Asian, 13% were Black, 6.5% were Hispanic, 68% were white, and 2.2% were “all others.” Of the 9.3% of screenings that resulted in abnormal mammograms, 265,309 examinations were included in the analysis evaluating same-day services.
Approximately 66% of the screening facilities performed same-day diagnostic services. Although onsite availability of most diagnostic services was similar across race and ethnicity groups, the researchers found that racial and ethnic minority groups were less likely to receive standard-of-care diagnostic imaging after abnormal screening compared with white patients.
“Despite having similar availability of diagnostic breast imaging services, there were substantial differences in whether patients received some of these services by race and ethnicity and neighborhood-level socioeconomic status,” Dr. Lawson said.
Racial or ethnic minorities were less likely to have access to some diagnostic technologies within 90 days of their abnormal screening. Compared to white patients, Asian and Black patients were less likely to undergo digital breast tomosynthesis.
Additionally, patients who identified as Asian, Black or Hispanic/Latinx were less likely to receive diagnostic imaging on the same day as their abnormal mammogram. However, Hispanic patients were more likely to receive same day biopsy in comparison to white or Black patients.
Patients living in neighborhoods with a lower average income also experienced disparities in access to diagnostic services.
The researchers note that some interventions may reduce disparities in timely breast cancer diagnosis, such as legislation to require health insurance plans to provide coverage of diagnostic breast imaging without out-of-pocket costs or the establishment of patient navigation services at facilities to help patients arrange timely appointments for diagnostic imaging.
“Future studies should assess other factors that may impact whether patients receive specific diagnostic breast imaging services, such as insurance status or patient preferences,” Dr. Lawson said. “In addition, we should seek to understand how diagnostic breast imaging accessibility, timeliness and quality ultimately impact breast cancer outcomes.”
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“Disparities in Standard-of-Care, Advanced, and Same-Day Diagnostic Services among Patients with Abnormal Screening Mammography.” Collaborating with Dr. Lawson were Weiwei Zhu, M.S., Diana L. Miglioretti, Ph.D., Tracy Onega, Ph.D., Louise M. Henderson, Ph.D., Garth H. Rauscher, Ph.D., Karla Kerlikowske, M.D., Brian L. Sprague, Ph.D., Erin J. A. Bowles, M.P.H., Ellen S. O’Meara, Ph.D., Anna N. A. Tosteson, Sc.D., Roberta M. diFlorio-Alexander, M.D., M.S., Rebecca A. Hubbard, Ph.D., Janie M. Lee, M.D., M.Sc., and Christoph I. Lee, M.D., M.S.
Radiology is edited by Linda Moy, M.D., New York University, New York, N.Y., and owned and published by the Radiological Society of North America, Inc. (https://pubs.rsna.org/journal/radiology)
RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)
For patient-friendly information on breast cancer screening, visit RadiologyInfo.org.
Journal
Radiology
Subject of Research
People
Article Title
Disparities in Standard-of-Care, Advanced, and Same-Day Diagnostic Services among Patients with Abnormal Screening Mammography
Article Publication Date
18-Feb-2025
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