Understanding disparities in same-day breast cancer diagnostics

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. 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."

Dr. Marissa Lawson, Assistant Professor, Radiology, University of Washington School of Medicine

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