Original article appeared on Lineburger Comprehensive Cancer Center News Feed聽
Radiology facilities and imaging process cited as factors that may lead to some disparities
A multi-institutional study led by 黑料网 Lineberger Comprehensive Cancer Center researchers and colleagues has found that diagnostic mammography results varied across racial and ethnic groups, with the rate of diagnostic accuracy highest in non鈥怘ispanic white women and lowest in Hispanic women.
The will be published June 17, 2022, in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.
Racial disparities and outcomes
The researchers reviewed 267,868 diagnostic mammograms; women were followed for one year after their mammogram to see if they developed breast cancer. The records came from 98 facilities in the Breast Cancer Surveillance Consortium, a mix of urban and rural locations spanning six states, including the , and were based on mammograms performed from 2005 to 2017.
An accurate cancer detection rate was highest in non鈥怘ispanic white women (35.8 per 1,000 mammograms) and lowest among Hispanic women (22.3 per 1,000 mammograms). A recommendation for short interval follow鈥恥p, which entails additional imaging after six months, was most common among non鈥怘ispanic Black women (31%). False鈥恜ositive biopsy recommendations, where a tissue biopsy was recommended but no breast cancer was found in the tissue sample, were most common among Asian/Pacific Islander women (169.2 per 1,000 mammograms).
鈥淓ven though we found some differences between racial and ethnic groups that we evaluated, none of the mammogram practices fell below the minimal acceptable standards for diagnostic interpretation that were published in 2013,鈥� said 黑料网 Lineberger鈥檚 , associate professor of radiology at 黑料网, adjunct assistant professor of epidemiology at the 黑料网 Gillings School of Global Public Health and corresponding author of the article. 鈥淥ur study is documenting differences in outcomes and giving us an understanding of how we can get better in terms of science and particularly, in delivering equitable healthcare.鈥�
Reducing diagnostic disparities
The researchers determined that a woman鈥檚 individual characteristics, such as age and other factors, did not explain the racial/ethnic variations found in diagnostic mammography performance. They did conclude, however, that two other factors contributed to some of the disparities: the imaging facility itself and concurrent use of breast ultrasound or MRI during the diagnostic process. These data suggest interventions that target the imaging facility and use of additional imaging modalities could help in reducing some diagnostic disparities.
鈥淚f our study showed that a factor was particularly important and impacted disparities, we hope to develop a follow-up study where we can really dig into those details because there are many factors that could affect differences by facility,鈥� Nyante said. 鈥淭here are a lot of things that are within a facility鈥檚 control, including scheduling and hiring of accredited radiologists.鈥�
Currently, many mammograms now utilize detailed three-dimensional imaging whereas, for the timeframe of this study, most mammograms were two-dimensional, making generalizations to current practice unclear and a factor that the researchers hope to follow up on in future research.
Authors and disclosures
In addition to Nyante, the other author at 黑料网 Lineberger and 黑料网 Gillings was ; Linn Abraham, MS, and Erin J. Aiello Bowles, MPH, Kaiser Permanente Washington Health Research Institute, Seattle; Christoph I. Lee, MD, University of Washington School of Public Health, Seattle; Karla Kerlikowske, MD, University of California, San Francisco; Diana L. Miglioretti, PhD, University of California, Davis; and Brian L. Sprague, PhD, University of Vermont, Burlington.
The research was supported by grants from the National Cancer Institute (P01CA154292, R01CA266377, U54CA163303 and R50CA211115), the Patient鈥怌entered Outcomes Research Institute (PCS鈥�1504鈥�30370) and the Agency for Health Research and Quality (R01 HS018366鈥�01A1).
Nyante reports no conflicts of interest to disclose.