Immediate mammogram readings reduce racial, ethnic disparities in care
Click Here to Manage Email Alerts
By reading mammograms immediately, providers can accelerate diagnostic workups and reduce racial and ethnic disparities in care, according to a study published in the American Journal of Roentgenology.
The research follows a previous pilot study that offered mammograms to hospitalized women who were overdue for breast cancer screenings and did not have an outpatient mammogram already scheduled. The women were covered by Medicaid or both Medicare and Medicaid.
The earlier study found that these patients often faced difficulties in keeping follow-up appointments, such as lack of transportation or an inability to take time off from work. Researchers noted that the COVID-19 pandemic widened these disparities.
After patients are screened, they typically are discharged and notified of their results hours or days later. Patients with abnormal findings are recalled for a second appointment, often scheduled days or weeks later, leading to diagnostic delays, wider subgroup disparities and patients lost to follow-up.
Streamlining care to a single appointment would improve care, the researchers said.
“The immediate-read screening mammography program reduced prior racial and ethnic disparities in same-day diagnostic imaging after abnormal screening mammograms,” author Brian N. Dontchos, MD, of Massachusetts General Hospital and Harvard Medical School, said in an American Roentgen Ray Society press release.
Dontchos and his colleagues implemented a program that used a dedicated breast imaging radiologist to interpret all screening mammograms in real time. Patients with negative or benign results were notified and discharged.
Patients who needed additional imaging were offered a diagnostic examination before they were discharged. A separate team of radiologists in the diagnostic clinic would interpret any recommended diagnostic studies.
For the study, the researchers retrospectively identified 8,222 screening mammograms that were performed before the program’s implementation between June 1 and Oct. 31, 2019, as well as 7,235 screening mammograms performed after the program’s implementation between June 1 and Oct. 31, 2020.
According to the researchers, 521 patients prior to the program’s implementation and 359 patients after the program’s implementation had abnormal screenings. Also, 14.8% of patients had same-day diagnostic imaging after abnormal screening mammograms prior to the program, and 60.7% of patients had same-day imaging after the program’s implementation.
Prior to the program, patients who were not white (16.9%) had lower odds than white patients (83.1%) of having same-day diagnostic imaging following abnormal screening examinations (adjusted OR = 0.3; 95% CI, 0.1-0.86; P = .03).
After the program was launched, however, the odds of white (84.6%) and non-white patients (15.4%) having same-day diagnostic imaging after abnormal screening examinations were not significantly different (aOR = 0.92; 95% CI, 0.5-1.71).
The researchers said that their program is sustainable and that it does not have to be limited to periods when there are lower screening volumes than normal.
Reference:
Dontchos BN, et al. AJR Am J Roentgenol. 2021;doi:10.2214/AJR.21.26597.
Perspective
Back to Top
Renee Kendzierski, DO
The screening mammograms are read in real time to decrease patient anxiety and wait time to final diagnosis. This model is beneficial to all patient populations. At Fox Chase Cancer Center, it decreases patient anxiety, as many of the patients are cancer survivors.
At Temple University Hospital, our patient population is of a lower socioeconomic status, and transportation to the hospital may be a problem. Getting any additional views on the patient at the time they present for the screening mammogram eliminates a delay in diagnosis, as patients may not return after a screening mammogram for additional workup. Also, if the screening mammogram and diagnostic mammogram are interpreted by the same physician, it provides continuity of care.
Although this model seems most beneficial for patients, there is a downside. Multiple patients needing additional views can cause havoc on an already tight patient schedule, and it may mean patients have to wait in the mammography department longer than anticipated. During the time of COVID-19, we try not to keep patients waiting in close quarters.
We really have no way of knowing who will need additional views, so that leaves the department vulnerable to large delays. This also limits the number of patients we can do in a day, since each patient waiting for results means time slots are a little longer. Lastly, obtaining prescriptions for additional views from the referring physician’s office also may cause further delay.
While I understand the benefit of reading screenings in real time, it is not without its faults. With the pandemic and all the financial uncertainties that stem from it, keeping patients waiting in the department for long periods of time and limiting the number of patients we see as a result may not be in our best interest. But ultimately, it is what is best for the patient, so we will continue to adjust our schedule to read these screening mammograms.
Collapse
Read more about
Click Here to Manage Email Alerts