Large Post-Mammography Study Shows Significant Racial and Ethnic Disparities with Breast Biopsy Delays

A large prospective study of over 45,000 women with abnormal findings on screening mammograms found significant racial and ethnic disparities associated with breast biopsy delays at 30, 60 and 90 days after screening.

The study, which was recently published in JAMA Oncology, examined data from 45,186 women who had abnormal findings on mammograms between 2009 and 2019.¹ Culling the data from 109 imaging centers in six states, the researchers noted the study population ranged between 40 and 79 years of age. The study population included 30,053 White women, 6,227 Black women, 5,644 Asian women, 3,055 Hispanic women and 1,206 women of other or mixed races, including native Hawaiian, Alaska natives, American Indians, and Pacific Islander women, according to the study.

The researchers found that 48 percent of Asian women, 43.3 percent of Black women, 42.8 percent of Hispanic women and 38.8 percent of women of other or mixed races did not have a biopsy 30 days after having abnormal findings on mammogram in comparison to 29.2 percent of White women.

While the differences declined with time, the researchers noted that 21.7 percent of Asian women, 19.5 percent of other or mixed races, 19.1 percent of Black women and 18.8 percent of Hispanic women had no biopsy 60 days after mammography screening in comparison to 14.2 percent of White women. At 90 days after mammography, 14.1 percent of Black women and 13.7 percent of women did not have a biopsy, according to the study.

“Although almost 90 percent of women in our cohort received a biopsy within 90 days of screening, the increased adjusted risk of no biopsy at 90 days for Black and Asian women is of particular importance in light of the Cancer Intervention and Surveillance Modeling Network study showing a decline in life-years gained with screening mammography after a 3-month delay in diagnostic testing,” wrote lead author Marissa B. Lawson, MD, an acting instructor of radiology at the University of Washington School of Medicine.² “Together, these findings suggest that racial and ethnic disparities in time to diagnosis may exacerbate disparities in breast cancer outcomes.”

The study authors speculated that factors specific to different health-care systems may have contributed to the racial and ethnic disparities observed with biopsy delays, noting that adjustment for imaging facilities comprised close to 30 percent of the additional risk of no biopsy 90 days after screening mammography.

“Our findings highlight an opportunity for radiology departments to consider where they can commit resources to improve wait times for biopsy,” noted senior author Christoph Lee, MD, a professor of radiology at the University of Washington School of Medicine. “This could include implementing changes in that diagnostic pathway such as using navigators to help guide patients through the process of scheduling exams and procedures.”

In an accompanying editorial, Randy C. Miles, MD, MPH, said feedback from minority groups about their mammography screening experience, increased hours for breast imaging services and consolidation of those services into fewer visits can have a considerable impact.³

“Access to same-day care, in particular, has been shown to eliminate previously seen disparities in time to biopsy between White and non-White patients following implementation,” noted Dr. Miles, division chief of breast imaging and associate director of radiology for research at Denver Health.⁴

In regard to study limitations, the authors noted the exclusion of breast imaging facilities with less than 75 percent biopsy capture may have contributed to underestimation of breast biopsy delays in racial and ethnic groups. According to Lawson and colleagues, other possible limitations include no assessment of the type of first biopsy performed and a lack of adjustment for the availability of on-site diagnostic services, factors that can affect the timing with biopsies.

References

1. Lawson MB, Bissell MCS, Miglioretti DL, et al. Multilevel factors associated with time to biopsy after abnormal screening mammography results by race and ethnicity. JAMA Oncol. Published online June 23, 2022. doi: 10.1001/jamaoncol.2022.1990. Available at: https://jamanetwork.com/journals/jamaoncology/article-abstract/2793713 .

2. Rutter CM, Kim JJ, Meester RGS, et al. Effect of time to diagnostic testing for breast, cervical, and colorectal cancer screening efficacy: a modeling study. Cancer Epidemiol Biomarkers Prev. 2018;27(2):158-164.

3. Miles RC. Addressing racial and ethnic differences in diagnostic resolution of abnormal mammographic findings. JAMA Oncol. Published online June 23, 2022. doi: 10.1001/jamaoncol.2022.1864 . Available at: https://jamanetwork.com/journals/jamaoncology/article-abstract/2793717

4. Dontchos BN, Narayan AK, Seidler M, Miles RC, Ebert E, Lehman CD. Impact of a same-day breast biopsy program on disparities in time to biopsy. J Am Coll Radiol. 2019;16(11):1554-1560.