Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations

Abstract

Objective Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavorable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound (US), magnetic resonance imaging (MRI), and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. Setting 73 United States imaging facilities across five Breast Cancer Surveillance Consortium regional registries during calendar years 2011–2012. Methods We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence. We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Results Facilities serving vulnerable populations were as likely (RR for MRI = 0.71 [95% CI 0.42, 1.19]; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for US = 1.38 [95% CI 1.09, 1.74]; RR for US-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Conclusions Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use.

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

“…Not all studies demonstrated differences by socioeconomic status, specifically with inpatient imaging services utilization [39], myocardial perfusion imaging utilization [40], and on-site availability of advanced breast imaging and image-guided biopsy services [41]. However, in the case of inpatient imaging utilization, hospitalizations facilitate more timely workup given that the uninsured tend to receive less timely care and imaging services as an outpatient [39].…”

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

“…Over the last decade, new imaging-based breast cancer screening technologies have emerged, including tomosynthesis, screening (automated) ultrasound, and breast MRI, which are rapidly changing the landscape of breast cancer screening [9][24–26]. These modalities show promise in improving sensitivity for detecting additional cancers when added to mammography, are FDA-approved, and are increasingly available in community settings [27–30].…”

“…With the advent of new screening technologies, including digital breast tomosynthesis, screening ultrasound, and breast MRI, there is growing concern that existing disparities will worsen [9], since typically, vulnerable populations have been the last to benefit from new health technologies [10][11]. 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 [12].…”

Right Pockets, Right Solutions: Aligning Investments to Address Breast Cancer Screening Disparities

“…However, despite them, evidence continues to consistently demonstrate disparities among vulnerable women, such as those of low socioeconomic status and with insufficient health care access or insurance [8]. The issue may continue to be more pronounced for women affected by more than one of these factors, such as Medicaid beneficiaries [9,10].…”