"A comprehensive analysis examining the causes of disparities is needed to design interventions to reduce them," study investigator Dr. Sarah Nyante of the University of North Carolina at Chapel Hill told Reuters Health by email.
"The analysis was motivated by prior research showing that there are racial and ethnic differences in breast-cancer characteristics at the time of diagnosis. The role that digital diagnostic mammography may play in those differences was unclear," she explained.
The aim of the current study was to evaluate racial/ethnic differences in the performance of diagnostic digital mammography conducted following a recent screening mammogram.
The research team used data from more than 267,000 diagnostic mammograms performed at 98 centers in the Breast Cancer Surveillance Consortium between 2005 and 2017. The women were 70% non-Hispanic white, 13% non-Hispanic Black, 10% Asian/Pacific Islander and 7% Hispanic. The researchers used BI-RADS assessments to identify mammograms that radiologists deemed likely malignant and likely benign.
As reported in Cancer Epidemiology, Biomarkers & Prevention, the invasive-cancer detection rate per 1,000 mammograms was highest among non-Hispanic white women (35.8), followed by Asian/Pacific Islander (31.6), non-Hispanic Black (29.5) and Hispanic women (22.3).
The positive predictive value was also highest among non-Hispanic white women, followed by Asian/Pacific Islander, non-Hispanic Black and Hispanic women.
Asian/Pacific Islander women were the most likely to receive a false-positive result (rate of 169.2 per 1,000), followed by Hispanic (136.1), Black (133.7) and white (126.5) women.
Non-Hispanic Black women were most likely to receive a false-negative report. The false-negative rate per 1,000 mammograms was 4.6 for Black women, 4.0 for white women, 3.3 for Asian/Pacific Islanders and 2.6 for Hispanic women.
Non-Hispanic Black women were the most likely to receive "short-interval follow-up recommendations," with 31.0% of women recommended for further imaging within six months. By comparison, 22.1% of white women, 16.1% of Asian/Pacific Islander women and 23.6% of Hispanic women received this recommendation.
There were also differences in the tumors detected through the diagnostic mammograms.
Overall, Asian/Pacific Islander women had the largest proportion of ductal carcinoma in situ (DCIS), while Black women were more likely to be diagnosed with later-stage tumors and higher tumor grade. As previous research has shown, they were also more likely to be diagnosed with the aggressive triple-negative breast-cancer subtype.
Controlling for patient-level characteristics did not explain the differences in performance statistics observed, suggesting that the role of the diagnostic facility in women's breast-cancer treatment should be further studied, the researchers say.
"The goal of our study was to measure the disparities. We did have some limited data that we used to explore potential causes, but there were a number of potentially important factors that we didn't have data on, including the characteristics of different facilities or why some women were referred for ultrasound/MRI and others were not," Dr. Nyante told Reuters Health.
"A study designed specifically to evaluate the causes of disparities in mammography outcomes would be needed to answer this question," she added.
SOURCE: https://bit.ly/3zOgjZw Cancer Epidemiology, Biomarkers & Prevention, online June 17, 2022.
By Megan Brooks
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