New research shows a significant racial disparity in the use of magnetic resonance imaging (MRI) and positron emission tomography (PET) for Medicare beneficiaries diagnosed with prostate cancer (PCa).
For the retrospective study, recently published in The Prostate, researchers reviewed Medicare insurance claims for 749,202 men diagnosed with PCa between 2019 and 2023. The cohort included White men (84 percent), Black men (8.7 percent), men of other races (4.1 percent) and men with unknown race/ethnicity (3.2 percent), according to the study.
The study authors found that Black men were 16 percent less likely to receive MRI and 13 percent less likely to receive PET imaging than White men.
“Given that Black men are often diagnosed with high‐risk disease, where advanced imaging is particularly important, these findings suggest a significant racial disparity in access to these diagnostic tools,” wrote lead study author Hanna Zurl, M.D., who is affiliated with the Department of Urology at Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues.
The multivariable analysis also revealed a 15 percent lower likelihood of MRI use for those residing in urban areas and a 20 percent lower likelihood for rural patients in comparison to men in metropolitan areas, according to the study authors.
Three Key Takeaways
- Significant racial disparities in imaging access. Black men with prostate cancer were 16 percent less likely to receive MRI and 13 percent less likely to receive PET imaging than White men, despite a higher likelihood of high-risk disease in which such imaging is crucial.
- Geographic disparities also evident. Men living in urban and rural areas were 15 percent and 20 percent less likely, respectively, to undergo MRI, and 11 percent and 17 percent less likely to undergo PET imaging compared to those in metropolitan areas.
- PET imaging use increasing overall, but not equally. While PET imaging for prostate cancer increased nearly fivefold from 2019 to 2023, disparities in access persist, highlighting concerns that new technologies may exacerbate existing racial and geographic health-care inequalities.
While men were nearly five times more likely overall to receive PET imaging for PCa in 2023 in comparison to 2019, the researchers found that men in urban areas were 11 percent less likely and rural residents were 17 percent less likely to have PET imaging in contrast to men in metropolitan areas.
“Although new technologies have the potential to improve diagnostic accuracy and disease outcomes, unequal access to these technologies could lead to the aggravation of racial and sociodemographic disparities,” emphasized Zurl and colleagues.
(Editor’s note: For related content, see “ASCO: Study Reveals Significant Racial Ethnic Disparities with PSMA PET Use for Patients with mPCa,” “African-American Men with Prostate Cancer Have Less Access to Cutting-Edge PET Care” and “Study Finds Key Benefits and Low Use of Pre-Op MRI for Patients Having Surgery for Prostate Cancer.”)
In regard to study limitations, the authors noted the lack of disease stage or Gleason score information in Medicare claims data, as well as a lack of assessment of neighborhood-level socioeconomic factors in the study. The researchers also conceded that the findings for a cohort of men 66 years of age and older may not be applicable to younger populations with PCa.
