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Racial disparity associated with incomplete mammography follow-ups

26th August 2022

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.

The World Health Organisation estimates that in 2020 there were 2.3 million women diagnosed with breast cancer and 685000 global deaths.

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.

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