Abstract
Background
Mammography is limited when analyzing dense breasts for 2 reasons: (1) breast density masks underlying cancers and (2) breast density is an independent risk factor for cancer. We undertook this study to assess whether there is a racial/ethnic difference in supplemental image ordering for women with dense breasts.
Methods
We conducted a retrospective, observational cohort study of women aged 50–75 from an academic medical center who had completed a screening mammogram between 2014 and 2016 that was read as BI-RADS 1 with heterogeneously or extremely dense breasts or BI-RADS 2 with extremely dense breasts. Data were abstracted on type, timing and frequency of supplemental imaging tests ordered within two years of an initial screening mammogram. Patient characteristics (age, race/ethnicity, insurance, and comorbidities) were also abstracted. We used bivariate and multivariate logistic regression to assess for differences in supplemental imaging ordered by race/ethnicity.
Results
Three hundred twenty-six women met inclusion criteria. Mean age was 58 years: 25% were non-Hispanic white, 30% were non-Hispanic black, 27% were Hispanic, 6% were Asian and 14% unknown. Seventy-nine (24%) women were ordered a supplemental breast ultrasound after the initial screening mammogram. Non-Hispanic black and Hispanic women were less likely to have supplemental imaging ordered compared to non-Hispanic white women (15% and 10%, respectively, vs. 45%, p < 0.0001). After controlling for patient age, ordering physician specialty, insurance, BI-RADS score, breast density, and family history of breast cancer, non-Hispanic black and Hispanic women remained less likely to be ordered supplemental imaging (OR 0.38 [95% CI 0.17–0.85] and OR 0.24 [95% CI 0.10–0.61], respectively, p < 0.0001).
Conclusion
Minority women with dense breasts are less likely to be ordered supplemental breast imaging. Further research should investigate physician and patient behaviors to determine barriers in supplemental imaging. Understanding these differences may help reduce disparities in breast cancer care and mortality.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahmed AT, Welch BT, Brinjikji W et al (2017) Racial disparities in screening mammography in the United States: a systematic review and meta-analysis. J Am Coll Radiol 14(2):157–165.e159
Davis C, Cadet TJ, Moore M, Darby K (2017) A comparison of compliance and noncompliance in breast cancer screening among African American women. Health Soc Work 42(3):159–166
Bhargava S, Moen K, Qureshi SA, Hofvind S (2018) Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiol 59(11):1285–1291
Freer PE (2015) Mammographic breast density: impact on breast cancer risk and implications for screening. Radiographics 35(2):302–315
Berg WA (2016) Current status of supplemental screening in dense breasts. Journal Clin Oncol 34(16):1840–1843
Mandelson MT, Oestreicher N, Porter PL et al (2000) Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 92(13):1081–1087
DenseBreast-info, Inc. (2018) Legislation and Regulations—What is Required? https://densebreast-info.org/legislation.aspx.
El-Bastawissi AY, White E, Mandelson MT, Taplin S (2001) Variation in mammographic breast density by race. Ann Epidemiol 11(4):257–263
Hitlin S, Brown JS, Elder JGH (2007) Measuring Latinos: racial vs ethnic classification and self-understandings. Soc Forces 86(2):587–611
Elmore JG, Nakano CY, Linden HM, Reisch LM, Ayanian JZ, Larson EB (2005) Racial inequities in the timing of breast cancer detection, diagnosis, and initiation of treatment. Med Care 43(2):141–148
Hoppe EJ, Hussain LR, Grannan KJ, Dunki-Jacobs EM, Lee DY, Wexelman BA (2018) Racial disparities in breast cancer persist despite early detection: analysis of treatment of stage 1 breast cancer and effect of insurance status on disparities. Breast Cancer Res Treat
Coughlin SS (2014) Intervention approaches for addressing breast cancer disparities among African American Women. Ann Trans Med Epidemiol 1(1).
Livaudais JC, Coronado GD, Espinoza N, Islas I, Ibarra G, Thompson B (2010) Educating Hispanic Women about breast cancer prevention: evaluation of a home-based promotora-led intervention. J Women's Health 19(11):2049–2056
Berg WA (2016) Supplemental breast cancer screening in women with dense breasts should be offered with simultaneous collection of outcomes data. Ann Intern Med 164(4):299–300
Berg WA, Blume JD, Cormack JB et al (2008) Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 299(18):2151–2163
Berg WA, Zhang Z, Lehrer D et al (2012) Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 307(13):1394–1404
Tagliafico AS, Mariscotti G, Valdora F et al (2018) A prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2). Eur J Cancer. 104:39–46
Alexandraki I, Mooradian AD (2010) Barriers related to mammography use for breast cancer screening among minority women. J Natl Med Assoc 102(3):206–218
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest to disclose and confirm that this manuscript has not been published elsewhere, nor is it under consideration by another journal. This manuscript has also not been previously submitted to Breast Cancer Research and Treatment. All authors have contributed to, reviewed, and approved the enclosed manuscript. Dr. Lin was supported by a National Cancer Institute Cancer Prevention and Control Career Development Award (1K07CA166462-01). The institutional review board at Icahn School of Medicine at Mount Sinai approved this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ezratty, C., Vang, S., Brown, J. et al. Racial/ethnic differences in supplemental imaging for breast cancer screening in women with dense breasts. Breast Cancer Res Treat 182, 181–185 (2020). https://doi.org/10.1007/s10549-020-05652-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-020-05652-z