‘We’re going in the wrong direction’: Race, income, education impeding women’s access to DBT

Women of minority races and ethnicities, with less education and income, haven’t been given equal access to the latest in breast cancer screening technology, despite being at higher risk for the disease, according to an investigation published Friday.

It’s well known that digital breast tomosynthesis detects more cancers and yields fewer false-positive readings than standard digital mammography, researchers explained in JAMA Network Open. But after reviewing more than 2.3 million exams performed across five states, Black women and socioeconomic-strapped populations received fewer DBT exams compared to their white peers, despite attending the same facilities.

And while patients’ access to these exams skyrocketed from 3% at the start of the study in 2011 up to 82% in 2017, the results did not shock senior author Diana Miglioretti, PhD.

"Given the large research sample and our longitudinal data collection, we were able to evaluate use by minority and traditionally underserved populations," Miglioretti, professor and division chief of biostatistics at the University of California Davis, added in a statement. "Unfortunately we were not surprised to find that these traditionally underserved populations were less likely to attend facilities that offered 3D mammography, and even when they did, they were less likely to receive a 3D mammogram."

In 2011, the U.S. Food & Drug Administration approved DBT as an alternative to digital mammography, yet it has been unclear whether groups with traditional barriers to screening have benefited from the technique’s enhanced capabilities.

So they reviewed screening exams included in the national Breast Cancer Surveillance Consortium, poring over those completed across 92 facilities between January 2011 and December 2017. They found DBT access was anything but equal.

For example, when both 2D and 3D mammograms were available, 37% of Black women received DBT compared to 43% of Asian-American women, 44% of Hispanic women, and 53% of white women.

This trend extended into education, as 41% of women with less than a high school diploma received 3D mammography compared to 50% of those who graduated from college.

Furthermore, DBT was more often afforded to women in ZIP codes with the highest quartiles of median household income compared to those living in the lowest quartiles (51% vs. 44%, respectively).

Miglioretti and colleagues could only theorize why these disparities exist, noting structural racism in healthcare environments and out-of-pocket costs may be “real barriers.” Insurance coverage and screening facility locations are also likely contributors, they added.

Whatever the cause, the researchers argued that something needs to be done to extend the best care to these underserved women who experience greater morbidity and mortality rates from breast cancer.

"We're going in the wrong direction,” added lead author Christoph Lee, MD, MS, a radiology professor at the University of Washington School of Medicine in Seattle. “You have a lot more women in certain subpopulations benefiting from new technologies and other subpopulations not. Existing disparities in breast cancer screening outcomes could widen unless these factors are addressed,” he explained.