News|Mammography| June 23, 2022

Structural Racism Cited in Study of Breast Biopsy Delays

Findings indicate unexplained disparities at screening sites influence the lag in follow-ups among nonwhite women, authors say.

Black women tend to experience lags in getting biopsies after a mammogram shows an abnormality.

Black women tend to experience lags in getting biopsies after a mammogram shows an abnormality.

June 23, 2022 — Black and Asian women are more likely than white women to experience significant delays in getting breast biopsies after amammogramidentifies an abnormality. Moreover, those delays appear to be influenced by screening site-specific factors that may stem fromstructural racism, according toresearch published today in JAMA Oncology.

“Even after adjusting for multiple factors thought to contribute todelayed diagnosis, we still see persistent disparities among minority women, particularly Black women. To me, this suggests that other underlying factors are contributing to these differences in time to biopsy,” said Dr.Marissa Lawson, the study’s lead author. She is an acting instructor of radiology at theUniversity of Washington School of Medicine.

The study reviewed the cases of 45,186 women whosescreening mammogramshad shown a tissue abnormality that called for a biopsy to ascertain whether it was cancerous. Across the study population, 34.6% of women were not biopsied within 30 days, 16% were not biopsied at 60 days, and 12% were not biopsied within 90 days.

The delays are concerning because previous studies have indicated that the benefit of screening diminishes with time, and these lags are associated with later-stage disease at time of diagnosis.

Using the time-to-biopsy of white patients as the benchmark, the researchers found that:

At 30 days out, Asian women had a 66% higher risk of not undergoing a biopsy, Black women, 52% higher, and Hispanic women, 50% higher.
At 90 days out, Black women had a 28% higher risk of not undergoing a biopsy. Among Asian women and Hispanic women, the risk was 21% higher and 12 % higher, respectively.

With that unadjusted model, the researchers then examined whether specific factors of individual patients, their neighborhoods and their screening facilities influenced the time to biopsy among women of different races and ethnicities.

“在控制了个体和社区水平的因素后，我们发现风险与未调整的模型并没有太大的不同，”Lawson解释道。“但当我们对参加的筛查设施进行控制时，活检的时间延迟减少了。”

Digging deeper, the investigators examined the influence of predesignated site-level factors — academic affiliation, screening-exam modality and the availability of onsite biopsy — and were surprised to find that none of those factors explained the overt difference.

“The findings indicate that there are some differences among the screening facilities associated with the time to biopsy. We just don't know what the specific differences are,” Lawson said.

The authors wrote, “Structural racism, within and beyond healthcare, may contribute to these differences.”

The screening sites are all associated with theBreast Cancer Surveillance Consortium, a U.S. network of breast imaging registries that is representative of the country’s population in terms of age, race and ethnicity.

“Our findings highlight an opportunity for radiology departments to consider where they can commit resources to improve wait times for biopsy. This could include implementing changes in that diagnostic pathway such as using navigators to help guide patients through the process of scheduling exams and procedures,” said Dr.Christoph Lee, a UW professor of radiology and the paper’s senior author.

The research was supported by theNational Cancer Institute(P01CA154292, R01CA266377, R35CA197289, U01CA199218, R50CA211115, T32CA009168, U54CA163303), thePatient-Centered Outcomes Research Institute(PCS-1504-30370), theAgency for Healthcare Research and Quality(R01 HS018366-01A1), the Lake Champlain Cancer Research Organization (021800), theBreast Cancer Surveillance Consortium, theUniversity of Vermont, theUniversity of California, Davis, and thePlacer County Breast Cancer Foundation.

For more information:https://www.uwmedicine.org/