Conference Presentation
Racial Disparities in the Proportion of Patients Returning for Annual Screening Mammograms
RSNA 2022
Mina Moussavi, Leeann Louis, Bryan Haslam, A. Gregory Sorensen
December 1, 2022
Purpose
Screening guidelines are increasingly being scrutinized for appropriateness for all racial groups, as evidence suggests that cancer incidence and mortality may differ by race. Any such changes might need to consider adherence to current guidelines among these racial groups to more realistically address cancer disparities. We sought to compare the percentage of patients returning for recommended annual screening by race/ethnicity in a large and diverse population across the USA.
Materials and Method
Screening mammography data was retrospectively collected from 186 clinical sites across the United States from 2017-2021. Screening exams from 1,391,248 patients above the age of 35 years (mean age 58.2 11.0 years) were collected. We reviewed patients with an initial exam prior to June 2019 and a subsequent screening exam 9-30 months later. The interval between initial and subsequent screening mammograms was defined as annual if they were 9-18 months apart and biennial if they were 19-30 months apart. We then analyzed the proportion of returning patients who were screened at the recommended annual cadence broken down by self-reported race and ethnicity. Confidence intervals were calculated using the adjusted Wald method.
Results
White patients (n=396,372) returned annually more often than Black (n=159,823) and Asian (n=81,276) patients at 75.8%, 71.4%, and 71.8%, respectively. The proportion of Hispanic/Latino (n=152,126), Native Hawaiian/Pacific Islander (n=6,066), and American Indian/Alaska Native patients (n=4,332) was the lowest of all ethnic groups at 69.6%, 69.1%, and 68.3%, respectively.
Conclusion
Black, Asian, and women from other non-White populations return for screening at a meaningfully lower rate than White women. As revisions to guidelines are being considered, these data on real-world adherence to existing guidelines might better inform any changes.
Clinical Relevance
Racial disparities in breast cancer screening adherence continue to persist and should be considered when updating mammography screening guidelines.
| Race / Ethnicity | Proportion of Women Who Returned Within 9-18 Months |
|---|---|
| White | 75.8 (75.6-75.9) |
| Black or African American | 71.4 (71.2-71.7) |
| American Indian or Alaska Native | 68.3 (66.9-69.6) |
| Asian | 71.8 (71.5-72.1) |
| Native Hawaiian or other Pacific Islander | 69.1 (67.9-70.2) |
| Multiple Race | 69.3 (67.8-70.7) |
| Other Race | 68.2 (67.5-68.8) |
| Hispanic or Latinx | 69.6 (69.4-69.9) |
Table 1.
Proportion of patients who returned for an annual screening mammogram (9-18 months after their prior screening exam) by self-reported race/ethnicity from 2017-2021. One exam between January 2017- June 2019 was randomly selected from each of the 1,391,248 patients across 186 sites to represent the initial screen and used as the starting time point for screening interval calculation during the 9-30 month follow-up period. 95% confidence intervals are indicated in brackets.
