Addressing Potential Health Disparities in the Adoption of Advanced Breast Imaging Technologies

Abstract

With the advent of new screening technologies, including digital breast tomosynthesis, screening ultrasound, and breast magnetic resonance imaging, there is growing concern that existing disparities among traditionally underserved populations will worsen. These newer screening modalities purport improved cancer detection over mammography alone but are not offered at all screening facilities and often require a larger co-pay or out-of-pocket expense. Thus, the potential for worsening disparities with regard to access and appropriate utilization of supplemental screening technologies exists. Currently, there is a dearth of literature on the topic of health disparities related to access and the use of supplemental breast cancer screening and their impact on outcomes. Identifying and addressing explanatory factors for persistent and potentially worsening disparities remain a central focus of efforts to improve equity in breast cancer care. Therefore, this paper provides an overview of factors that may contribute to present and future disparities in breast cancer screening and outcomes, and explores specific relevant topics requiring greater research efforts as more personalized, multimodality breast cancer screening approaches are adopted into clinical practice.

Comparative Access to and Use of Digital Breast Tomosynthesis Screening by Women’s Race/Ethnicity and Socioeconomic Status

“… 12 , 15 Persistent differences in DBT use between Black and White women may suggest a widening of cancer screening disparities, because DBT is associated with improved outcomes in terms of both improved cancer detection and lower false-positive rates for some subgroups of women. 1 , 8 , 9 , 11 , 29 , 30 …”

“…Although diffusion of DBT screening in the US has been relatively rapid, it is unknown whether adoption has occurred equally across different populations. 11 Populations with traditional disparities—Black race, Hispanic ethnicity, lower educational level, or lower income level—have historically experienced greater breast cancer morbidity and mortality than their less disadvantaged counterparts. 12 , 13 , 14 These populations have also historically been the last to benefit from newer medical technologies.…”

Radiology Support, Communication, and Alignment Network and Its Role to Promote Health Equity in the Delivery of Radiology Care

“…Glover et al [8] note that the effect of race and language on a patient's interaction with the health care system is complex. Factors that include health literacy, medical mistrust, clinician bias, cultural differences, and linguistic barriers play a role [9][10][11][12][13]. In this article, we provide a brief review of the literature on health disparities in imaging and describe how Radiology Support, Communication, and Alignment Network (R-SCAN) promotes health equity.…”

An Introduction to Health Disparities for the Practicing Radiologist

“…Others have demonstrated variable rates or times to diagnostic follow-up after screening mammography among African-American and Hispanic women [12,13]. Still others have raised concerns about utilization of advanced breast imaging modalities, such as MRI or tomosynthesis [14]. Potential disparities have also been explored in low-dose CT screening for lung cancer in a population with higher minority representation than the original National Lung Screening Trial [15].…”