Diagnostic mammogram accuracy varies across racial, ethnic groups
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Diagnostic mammography performance appeared to vary across racial and ethnic groups, according to study results published in Cancer Epidemiology, Biomarkers & Prevention.
Some of these disparities may be reduced through interventions that address characteristics associated with imaging facility and access instead of personal characteristics, researchers noted.
Rationale and methods
“Numerous studies have shown racial and ethnic differences in breast cancer characteristics at the time of diagnosis, but the causes of the differences have not been fully identified,” Sarah J. Nyante, PhD, associate professor of radiology at The University of North Carolina School of Medicine, told Healio. “An earlier study addressing how diagnostic mammography might be related to these differences used film-screen mammography, which is no longer used. We wanted to provide an update on this issue, this time among women who received digital mammograms, which is the current standard of care.”
Nyante and colleagues evaluated differences in diagnostic mammography performance based upon race and ethnicity using information from 267, 868 diagnostic mammograms performed across 98 facilities in the Breast Cancer Surveillance Consortium during 2005 and 2017.
The researchers ascertained breast cancers that occurred within 1 year, calculated performance statistics for each racial and ethnic group, and used multivariable regression to control for personal characteristics and imaging facility among women whose mammograms they studied.
Key findings
Results showed white women had the highest rate of invasive cancers detected per 1,000 mammograms performed (35.8; 95% CI, 35-36.7), followed by Asian/Pacific Islander (31.6; 95% CI, 29.6-33.8), Black (29.5; 95% CI, 27.8-31.4) and Hispanic (22.3; 95% CI, 20.2-24.6) women.
After measuring cancer yield among positive mammograms, researchers observed the highest positive predictive value among white women (27.8; 95% CI, 27.3-28.3), followed by Asian/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) women.
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 among white women.
In addition, 31% of Black women received a recommendation for further imaging within 6 months compared with only 23.6% of Hispanic women, 22.1% of white women and 16.1% of Asian/Pacific Islander women.
Researchers also observed differences in tumors detected through diagnostic mammograms. Asian/Pacific Islander women had the largest proportion of ductal carcinoma in situ, and Black women had the most late-stage tumors and higher tumor grade, as well as a higher likelihood of diagnosis with an aggressive triple-negative breast cancer subtype.
Controlling for patient-level factors could not explain the difference in performance measures observed in the study, Nyante noted.
Study limitations of included the fact that digital breast tomosynthesis has become more widely available in recent years, thus, the study findings may not be entirely generalizable to the current imaging industry.
Next steps
Researchers plan to conduct a parallel analysis among women who received a diagnostic mammogram after reporting a breast problem or symptoms such as a breast lump, Nyante said.
“All women included in the current study received their diagnostic mammogram after having a screening mammogram,” she said. “Women with symptoms are typically diagnosed with worse-prognosis breast cancers than screening participants, so it will be interesting to see if we observe the same types of racial/ethnic differences in diagnostic mammography performance in women with symptoms and how that is reflected in the tumor characteristics of the population.
References:
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. Cancer Epidemiol Biomarkers Prev. 2022;doi:10.1158/1055-9965.EPI-21-1379.
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