Advanced breast imaging services scarce in nonacademic, nonradiology practices

Not all mammography screening facilities are created equal. A recent study into the characteristics of various facilities across the country found women who seek screening at multispecialty breast centers or full diagnostic radiology practices are more likely to also have advanced breast imaging services at the same location compared with women who go to nonradiology or breast imaging-only practices.

The study, published online in Academic Radiology, suggested that women attending facilities with the more advanced capabilities will be less likely to have to travel elsewhere for a complete diagnostic evaluation.

“Our findings may be important for referral of patients as attending multiple facilities for imaging purposes may result in delays in diagnosis, greater lost time, and out-of-pocket expenses from added travel, potential repeat imaging with a change in institution, or potential medical errors with the transfer of clinical and imaging data between facilities,” wrote Christoph I. Lee, MD, MSHS, of the University of Washington School of Medicine in Seattle, and colleagues.

The authors tapped in data from the National Cancer Institute-funded Breast Cancer Surveillance Consortium to identify 105 imaging facilities offering screening mammography from six regional registries.

Results showed breast MRI availability was particularly limited and not available at any nonradiology or breast imaging-only facilities. Nonradiology practices were defined as an imaging facility operated by a different specialty, such as obstetrics and gynecology.

A combination of breast ultrasound, breast MRI and image-guided breast biopsy services were available at 76 percent of multispecialty breast centers and 75 percent of academic facilities, compared with 22.2 percent of full diagnostic radiology practices and 29 percent of facilities without an academic affiliation.

Supplemental screening ultrasound and screening MRI were both available in 28 percent of multispecialty breast centers compared with 4.7 percent of full diagnostic radiology practices. Both supplemental screening modalities were available at 25 percent of academic facilities compared with just 8.5 percent of nonacademic facilities.

“Interestingly, many facilities offering diagnostic [ultrasound] and diagnostic breast MRI services did not offer screening [ultrasound] or screening breast MRI services,” wrote Lee and colleagues. “This was true across all categories of facilities, regardless of for-profit status, academic affiliation, or practice type. This finding suggests that other factors, such as financial reimbursement or adherence to screening guidelines and recommendations, may be affecting the on-site availability of supplemental breast cancer screening services.”

The authors noted that the status of a facility as for-profit or not for profit was less strongly related to advanced breast imaging service availability than practice type or academic affiliation.

“On the basis of our analysis, patients seeking to obtain all their breast imaging for the full potential breast care continuum at one location are most likely to find a combination of multiple advanced modalities and imaging-guided biopsy services at multispecialty breast centers, followed by full diagnostic radiology practices,” they concluded.