Fewer African American Women Screened with Digital Breast Tomosynthesis

February 23, 2021
Whitney J. Palmer

While digital breast tomosynthesis improves cancer detection and recall rates among women of all ages and races, significantly fewer African American women have access to the exam.

African American women are more likely to experience better breast cancer detection and lower recall rates with digital breast tomosynthesis (DBT) – that is, if they can get the exam.

New research published Feb. 19 in the Journal of the American College of Radiology, showed that while DBT benefits women of all ages and races, it is not used equally across all racial groups, leading to disparities in patient outcomes. In particular, when compared to white women, African American women were not only less likely to receive DBT, but they were also less likely to be screened multiple times during a five-year timeframe.

“Racial differences in screening frequency and DBT utilizations are likely rooted in social, economic, cultural, and educational disparities,” said the team led by Emily Conant, M.D., division chief of breast imaging at PennMedicine. “Black women are more likely to be diagnosed with breast cancer at a younger age and more advanced stage and to die from breast cancer.”

The results of this study, Conant’s team said, should prompt institutions to assess DBT utilization across women of all races included in their patient populations, as well as invest in educating providers about the benefits of more frequent DBT screening.

Related Content: Race, Lower Income, Less Education Reduce DBT Access

To get a clear picture of how DBT is used across racial groups, Conant’s team conducted a retrospective study of 63 breast imaging facilities nationwide from 2015 to 2019. From 385,503 women, they gathered 804,304 mammograms – 542,945 DBT scans and 261,359 digital mammography (DM) screenings. They included only women with no history of cancer or breast implants.

Based on their analysis, they picked up on several DBT benefits that held true across racial and age groups. Overall, the aggregate recall rate was 8.74 percent for DBT compared to 10.06 percent for DM. The cancer detection rate was also better for women who received DBT – 4.73 for DBT compared with 4.60 for DM. In addition, the positive predictive value for recall was also greater with DBT overall (5.29 compared with 4.45, respectively).

But, when the team dug deeper, they found that, of the DBT screenings included in the study, African American women received the least. Only 44 percent of African American women underwent DBT compared to 63 percent of Asian women and 61 percent of white women. They were also less likely to receive more than one screening exam – 57 percent of the African American women in the study were screened two or more times compared with 63.7 percent of white women. When the team adjusted for age and institution, the difference was significant with an odds ratio of 0.895. However, the team did note that African American women who underwent DBT did have lower recall rates than white women.

Overall, the team said, their results reiterate that DBT improves patient screening metrics, including recall rate, cancer detection, and positive predictive value for women of all ages and races.

With this knowledge, providers can make decisions for better DBT utilization, the team said.

“If providers are educated about the benefits of more frequent screening applicability of risk scores for across racial groups, and the improved screening outcomes achieved with DBT, they may promote DBT uptake by their patients, potentially resulting in increased DBT access,” they said. “Interventions that increase awareness and enable primary care and breast imaging providers to decrease barriers to screening, particularly DBT, could have a positive impact.”

Such changes could open the door for earlier diagnosis and better patient outcomes for African American women. But, they could also have other, non-clinical positive impacts for patients.

“Benefits of improvements in these screening metrics likely include decreases in patient stress, time away from work, cost for diagnostic imaging, and the number of biopsies with benign results,” they said, adding that the cost associated with false-positive screenings can be a significant financial burden on women in lower socioeconomic groups.

Ultimately, the team said that their findings point to the need for overcoming these existing disparities in an effort to drive up DBT use for better breast cancer screening.

“This study suggests that the addition of DBT screening to DM is associated with improved screening performance, including improved [recall rate,] [cancer detection rate,] and [positive predictive value] across all racial groups,” they concluded. “Therefore, these data suggest that overcoming the existing disparities in DBT utilization may be key to improvement in the effectiveness and equity of breast cancer screening.”

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