ARRS 2022 Abstracts

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2079. Racial Disparities of Screening-Detected in One-View Asymmetries via 2D Digital Mammography versus Tomosynthesis
Authors * Denotes Presenting Author
  1. Brielle Paolini *; Medical University of South Carolina
  2. Margaret Manning; Medical University of South Carolina
  3. Heather Collins; Medical University of South Carolina
  4. Madelene Lewis; Medical University of South Carolina
Objective:
This study aims to investigate racial disparities and likelihood of follow-up of screen-detected, one-view asymmetries seen on 2D digital mammography (2D DM) versus digital breast tomosynthesis (DBT).

Materials and Methods:
An IRB-approved, HIPPA-compliant retrospective review was conducted of all women with screening mammograms performed at our institution during the period April 2016 - March 2020. Institutional database and electronic medical records were reviewed for mammographic findings, patient follow-up, and demographic variables such as race. Chi-square test with Fisher’s exact tests were used in cases with 5 or fewer patients in a group was used to examine an association between modality (2D DM v. DBT) and race (i.e. Caucasians, African Americans, Asians, Latin Americans/ Hispanics, and unknown), between modality and follow-up, and between race and follow-up. Statistical significance was set at a < 0.05 threshold with two-sided p-values reported and analyses were conducted with SPSS version 25 (IBM: Armonk, NY).

Results:
During the study period, 53,587 total screening mammograms were performed and 6,612 were called back for diagnostic imaging. Of those called back, 311 patients were recalled for an asymmetry including 136 recalled via DBT and 175 recalled via 2D DM. Caucasians were the largest racial group with 193 patients recalled for asymmetries with 50.8% recalled via 2D DM and 49.2% recalled via DBT. The second largest group was African Americans with 104 patients recalled with 67.3% via 2D DM and 32.7% via DBT. The other groups comprised Asians with 4 participants (25% 2D DM, 75% DBT), Hispanic/Latin American with 6 participants (66.6% 2D DM, 33.3% DBT) and 4 unknown patients (50% 2D DM, 50% DBT). Given the small sample size of the other racial groups, statistics were performed comparing Caucasians and African Americans. Specifically, Caucasians were significantly more likely to undergo DBT (49.2 %) than African Americans (32.7%, p= 0.007). Of the patients assigned a BIRADS 3 at diagnostic mammography (311), 95.82% of patients followed up (298/311). The patients who did not follow up were more likely to have undergone a 2D exam (84.6%; 11/13) than the patients who did follow up (55.0%; 164/298), p = 0.04. Follow-up rates did not differ significantly between African American (96.2%; 100/104) and Caucasian (95.9%; 185/193) patients, p = 1.00.

Conclusion:
A retrospective review of patients recalled for breast asymmetries on screening mammography demonstrated that Caucasians were significantly more likely to undergo DBT screening compared to African Americans. Moreover, patients who underwent DBT screening were significantly more likely to follow-up after receiving a BIRADS 3 category at diagnostic mammogram than those who underwent 2D screening. These findings highlight an important healthcare disparity with women of minority race having less access to DBT screening during 2016-2020. Future work should help identify underlying racial, ethnic, and community barriers that decrease access to DBT screening as well as a concerted effort made to remove these barriers.