Racial Differences in False-positive Mammogram Rates

Abstract

Background Mammography screening reduces breast cancer mortality, but false-positive tests are common. Few studies have assessed racial differences in false-positive rates. Objectives We compared false-positive mammography rates for black and white women, and the effect of patient and facility characteristics on false-positives. Research Design and Subjects Prospective cohort study. From a sample of the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST), we identified black/African American (N=3176) or white (N=26,446) women with no prior breast surgery or breast cancer. Measures Race, demographics, and breast cancer risk factors were self-reported. Results of initial digital and film mammograms were assessed. False-positives were defined as a positive mammogram (Breast Imaging Reporting and Data System [BIRADS] category 0, 4, 5) with no cancer diagnosis within 15 months. Results The false-positive rate for digital mammograms was 9.2% for black women compared to 7.8% for white women (p=0.009). After adjusting for age, black women had 17% increased odds of false-positive digital mammogram compared to whites (OR=1.17, 95% CI 1.01-1.35, p=0.033). This association was attenuated after adjusting for patient factors, prior films and study site (OR=1.04, 95% CI 0.91-1.20, p=0.561). There was no difference in the occurrence of false-positives by race for film mammography. Conclusion Black women had higher frequency of false-positive digital mammograms explained by lack of prior films and study site.The variation in the disparity between the established technique (film) and the new technology (digital) raises the possibility that racial differences in screening quality may be greatest for new technologies.

Validating racial and ethnic non-bias of artificial intelligence decision support for diagnostic breast ultrasound evaluation

“…7,18 Mammographic accuracy, for example, has been shown to vary greatly based on institution and radiologist, with poorer performance at facilities that treat predominantly minority and low-income women. 18 Facilities that serve mostly racial/ethnic minority groups may have a history of chronic underinvestment, as NYC neighborhoods differ drastically in insurance coverage rates, income level, breast cancer rates. 19 Structural racism in and outside of healthcare centers negatively impact racial and ethnic minorities and are associated with worse healthcare access and outcomes.…”

“…Lack of prior images is associated with higher false positive rates. 3,18 This issue may be more common among populations with less access to care. Availability of prior comparison studies have been shown to reduce false positive recalls for all breast imaging modalities, decreasing from 20.9% in first screening ultrasound to 10.7% in the second and third year follow-up.…”

“…The significant difference in distribution of racial and ethnic groups may reflect the inherent differences in distribution per neighborhood within New York, United States. Studies have shown that a variety of performance across racial and ethnic groups can be related to the imaging facility and access rather than personal characteristics 7 , 18 . Mammographic accuracy, for example, has been shown to vary greatly based on institution and radiologist, with poorer performance at facilities that treat predominantly minority and low-income women 18 .…”

Leveraging system sciences methods in clinical trial evaluation: An example concerning African American women diagnosed with breast cancer via the Patient Navigation in Medically Underserved Areas study

“…Based on current practices, women are assumed to be navigated until they complete care (e.g., diagnostic follow-up; treatment). For breast cancer, we will use data from published literature for AAs' prevalence of breast cancer risk factors [90,91], breast cancer transition probabilities [92], rates of false-positives and false-negatives [[92], [93], [94], [95]], linkages between screening and stage at diagnosis [49,96,97], NCI's Surveillance Epidemiology and Ends Results (SEER) data for AAs' cancer incidence, stage at diagnosis, and survival data [98].…”

Breast cancer survival disparity between African American and Caucasian women in Arkansas: A race-by-grade analysis

“…Although the overall incidence of breast cancer is lower among African American (AA) women compared with Caucasian women, AA breast cancer patients of all ages are more likely to have advanced disease at diagnosis, an increased risk of recurrence and a poorer prognosis ( 2 – 6 ). Racial disparities in breast cancer mortality in the US persist, with AA breast cancer patients experiencing higher mortality rates compared with their Caucasian counterparts ( 7 – 9 ). Recent data from the 50 largest US cities confirms the trend of increasing racial disparities ( 8 ).…”