Racial disparity is linked with a delayed follow-up of abnormal screening mammography increasing the possible risk of malignant progression
Racial disparity appears to be a significant factor in delayed follow-up among women who have an incomplete screening mammography and which has the potential for malignancy progression according to the findings of a study by researchers from New York, USA.
Screening mammography provides a means for the early detection of breast cancer and a 2007 systematic review found a 7% to 23% reduction in breast cancer mortality rates with screening mammography in women 40 to 49 years of age.
The Breast Imaging Reporting and Database System score (BI-RADS) is used by radiologists to describe the results of a mammogram and categorises the scans from 0 to 6. A BI-RADS score of 0 indicates an incomplete test and requires additional tests and images to provide a final assessment.
The National Breast and Cervical Cancer Early Detection Program in the US, has set a standard that the timeline from abnormal screening result to final diagnosis is 60 days for breast cancer screening. Factors known to be associated with delayed follow-up include language barriers although the impact of other factors is less clear.
In the present study, the US researchers sought to further identify risk factors for delayed follow-up of abnormal screening results and undertook a retrospective, observational study of individuals with a BR-RADS-0 screening mammogram.
At the first visit, individuals answered a questionnaire that provided routine electronic clinical and sociodemographic characteristics and the research team examined the factors associated with a < 60 day and a > 60 day delay.
Racial disparity and follow-up delays
A total of 4,552 individuals were included and among those having a follow-up, 76.7% did so within 60 days.
When the researchers looked at factors associated with delays > 60 days, there were clear racial disparities. For example, individuals self-identifying as Black, had a 1.64 increased odds (95% CI 1.54 – 1.75, p < 0.0001) of a > 60 day delayed follow-up compared to those of White ethnicity.
This was also seen for those of Asian ethnicity (odds ratio, OR = 1.43, 95% CI 1.27 – 1.58, p = 0.022) as did those self-identifying as “other” (OR = 1.45, 95% CI 1.32 – 1.58, p = 0.005). However, among those of Hispanic heritage, the difference was not significant (OR = 1.05, 95% CI 0.93 – 1.17, p = 0.69).
There was also a higher odds for a delayed follow-up among those who completed their questionnaire in Spanish (OR = 1.67, 955 CI 1.51 – 1.83).
Further analysis also highlighted racial disparities. For instance, White individuals had a shorter median follow-up compared to Black and those identified as “other”.
The authors concluded that with racial disparities associated with an increased risk of delayed follow-up for abnormal mammography screening, further work is required to identify the causes for these delays.
Citation
Platt S et al. BI-RADS-0 screening mammography: Risk factors that prevent or delay follow-up time to diagnostic evaluation J Am Coll Radiol 2022
