Racial Disparities and Strategies for Improving Equity in Diagnostic Follow-Up for Abnormal Screening Mammograms

Author:

Manik Ritika1ORCID,Grady Connor B.234ORCID,Ginzberg Sara P.3567ORCID,Edmonds Christine E.38ORCID,Conant Emily F.38ORCID,Hubbard Rebecca A.23ORCID,Fayanju Oluwadamilola M.3567ORCID

Affiliation:

1. Harvard Medical School, Boston, MA

2. Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA

3. Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA

4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA

5. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA

6. Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA

7. Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA

8. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA

Abstract

PURPOSE Black and White women undergo screening mammography at similar rates, but racial disparities in breast cancer outcomes persist. To assess potential contributors, we investigated delays in follow-up after abnormal imaging by race/ethnicity. METHODS Women who underwent screening mammography at our urban academic center from January 2015 to February 2018 and received a Breast Imaging Reporting and Data System 0 assessment were included. Kaplan-Meier estimates described distributions of time between diagnostic events from (1) screening to diagnostic imaging and (2) diagnostic imaging to biopsy. Multivariable logistic regression models estimated the associations between race/ethnicity and receipt of follow-up within 15 and 30 days. RESULTS Two thousand five hundred and fifty-four women were included (48.6% non-Hispanic [NH] Black, 38.2% NH White, 13.1% other/unknown). Median time between screening and diagnostic imaging varied by race/ethnicity (White: 7 days [IQR, 2-14]; Black: 12 days [IQR, 7-23]; other/unknown: 9 days [IQR, 5-21]). There were similar disparities in days between diagnostic imaging and biopsy (White: 12 [IQR, 7-24]; Black: 21 [IQR, 13-37]; other/unknown: 16 [IQR, 9-30]) and between screening and biopsy (White: 20 [IQR, 11-41]; Black: 35 [IQR, 22-63]; other/unknown: 27.5 [IQR, 17-42]). After adjustment, odds of diagnostic imaging follow-up within 15 days of screening were lower for Black versus White women (odds ratio, 0.59 [95% CI, 0.44 to 0.80]; P < .001). CONCLUSION In this diverse cohort, disparities in timely diagnostic follow-up after abnormal breast screening were observed, with Black women waiting 1.75 times as long as White women to obtain a tissue diagnosis. National guidelines for time to diagnostic follow-up may facilitate more timely breast cancer care and potentially affect outcomes.

Publisher

American Society of Clinical Oncology (ASCO)

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