Investigators may have uncovered racial and ethnic disparities in the receipt of same-day diagnostic services and biopsies following abnormal mammogram findings in spite of the similar availability of diagnostic technologies, according to a recent study published by Lawson et al in Radiology.
Background
“Getting a screening mammogram is an anxiety-inducing experience for a lot of [individuals], and most patients [we] encounter want their results as soon as possible,” noted lead study author Marissa Lawson, MD, Assistant Professor of Radiology at the University of Washington School of Medicine.
Study Methods and Results
In the retrospective study, the investigators analyzed the data of over 1.1 million women aged 40 to 89 years and over 3.5 million screening mammograms performed between January 2010 and December 2020 across six U.S. states at 136 screening facilities. The screening results were from individuals who self-identified as White (68%), Black (13%), Asian (10%), Hispanic or Latinx (6.5%), and "all others" (2%). The investigators sought to better understand how factors such as race and ethnicity, household income, and neighborhood educational attainment could affect access to and use of breast cancer diagnostics.
“We’re looking at how the diagnostic workup process might contribute to the population disparities we see with breast cancer outcomes,” detailed Dr. Lawson “It was surprising to find similar availability of technologies across racial and ethnic groups, [b]ut we still saw big differences in who was getting those same-day services,” she emphasized.
The investigators first identified which consortium facilities offered onsite access to both standard care and advanced diagnostics as well as biopsy. They then measured patients’ access to these capabilities, discerned which screening mammograms yielded abnormal results, and evaluated those patients’ receipt of diagnostic imaging and biopsy on the same day and within 90 days at facilities that had the onsite technology and capability.
After adjusting for several potentially influential factors like patient breast density, biopsy history, and personal and family history of breast cancer, the investigators revealed that even when breast-care facilities had the necessary technology and capabilities, minority women 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.
Asian, Black, and Hispanic/Latinx patients received fewer same-day diagnostic services following abnormal mammogram results at facilities offering any diagnostic or biopsy services. Further, patients who lived in the lowest-income neighborhoods were 58% less likely to receive same-day diagnostic evaluations compared with those living in the highest-income neighborhoods. Notably, patients residing in rural areas were more likely to receive same-day diagnostic services compared with those residing in urban areas. Black patients and those who had a relatively lower median income were less likely compared with White patients to receive same-day biopsy at a capable facility. However, Hispanic/Latinx patients were more likely compared with White patients to receive same-day biopsy.
Conclusions
The investigators noted that study limitations included that the participants involved in the study might not have been nationally representative of women’s education and rural residency. In addition, variables that might affect patients’ ability to take advantage to clinic services such as employment, insurance status, transportation barriers, and child-care needs were not included in the analyses. The investigators were also uncertain about whether individual patients declined the opportunity for same-day services or were not offered such services.
“If [patients are] 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 [hardship] with work or transportation—that’s better for the patient. [I]f 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,” Dr. Lawson concluded.
Disclosure: The research in this study was funded by the National Cancer Institute. For full disclosures of the study authors, visit pubs.rsna.org.
