Source/Disclosures
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Disclosures:
The Agency for Health Research and Quality, NCI and the Institute for Patient-Centered Outcomes Research supported the study. Nyante does not report any relevant financial information. Please see the study for relevant financial information from all other authors.
According to the results of studies published in Cancer epidemiology, biomarkers and prevention.
Some of them disparities can be reduced through interventions that address characteristics associated with imagery facility and access rather than personal characteristics, the researchers noted.
Data derived from Nyante SJ, et al. Biomarkers of cancer epidemiol Previous. 2022;doi:10.1158/1055-9965.EPI-21-1379.
Rationale and methods
Previous studies have identified socioeconomic and biological factors as possible causes of racial disparities in breast cancer, but potential differences related to the diagnostic mammography process have not been explored, according to Sarah J. Nyante, PhD, associate professor of radiology at the University of North Carolina School of Medicine.
Sarah J. Nyante
“Breast imaging is an important first step to being diagnosed and entering the treatment journey. It is reasonable to think that differences at the start of care would affect later outcomes,” she said in a press release.
Nyante and colleagues assessed differences in diagnostic mammography performance based on race and ethnicity using information from 267,868 diagnostic mammograms performed at 98 Breast Cancer Surveillance Consortium facilities in 2005 and 2017.
The researchers determined which breast cancers occurred within the year, calculated performance statistics for each racial and ethnic group, and used multivariate regression to control for personal characteristics and imaging facilities in the women whose mammograms they studied. .
Main conclusions
The results showed that white women had the highest rate of invasive cancers detected per 1000 mammograms performed (35.8; 95% CI, 35-36.7), followed by Asians/Pacific Islanders (31 .6; 95% CI, 29.6-33.8), Blacks (29.5; 95% CI, 27.8-31.4) and Hispanics (22.3; 95% CI, 20 ,2-24.6).
After measuring cancer yield among positive mammograms, researchers observed the highest positive predictive value in white women (27.8; 95% CI, 27.3-28.3), followed by Asians / Pacific Islander (24.3; 95% CI, 23.2-25.4), Black (23.4; 95% CI, 22.3-24.5) and Hispanic (19.4; 95% CI, 18-20.9).
Of note, Asian/Pacific Islander women had the highest false positive rate at 169.2 per 1,000 mammograms, followed by 136.1 among Hispanic women, 133.7 among Black women, and 126, 5 in white women.
Additionally, 31% of black women received a referral for additional imaging within 6 months, compared to only 23.6% of Hispanic women, 22.1% of white women, and 16.1% of Asian/Pacific Islander women .
The researchers also observed differences in the tumors detected by diagnostic mammograms. Asian/Pacific Islander women had the highest proportion of ductal carcinomas in situ, and black women had the most late-stage tumors and higher tumor grade, as well as a higher likelihood of being diagnosed with a sub -aggressive type of triple negative breast cancer.
Controlling for patient-level factors could not explain the difference in performance measures seen in the study, Nyante noted.
Limitations of the study included the fact that digital breast tomosynthesis has become more widely available in recent years, therefore, the study results may not be fully generalizable to the current imaging industry.
Consequences
Nyante recommended further research into the role of diagnostic facilities in the treatment of female breast cancer.
“Examining differences in diagnostic digital mammography performance and tumor characteristic results by race and ethnicity can help us understand why disparities in cancer detection and quality of care persist for certain groups. demographics,” Nyante said in the press release.
References:
The accuracy of diagnostic mammograms may vary across racial and ethnic groups (press release). Available at: www.aacr.org/about-the-aacr/newsroom/news-releases/accuracy-of-diagnostic-mammograms-may-vary-across-racial-and-ethnic-groups/. Published June 17, 2022. Accessed June 17, 2022.
Nyante SJ, et al. Biomarkers of cancer epidemiol Previous. 2022;doi:10.1158/1055-9965.EPI-21-1379.
Race and medicine
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