Diagnostic Mammography Outcomes Vary Among Racial and Ethnic Groups

BCSC study finds that diagnostic mammography performance varies across racial and ethnic groups

Posted by Sarah Nyante at 11:30 AM on Jun 24, 2022


Prior research has documented significant racial and ethnic differences in breast cancer incidence and prognosis. Differences in risk factors, socioeconomic status, health insurance coverage, provider actions, access to timely treatment, and access to high-quality care have been shown to contribute to these disparities, but controlling for these factors does not eliminate the differences, suggesting that there are other contributing factors. In this study, BCSC researchers evaluated differences in diagnostic mammography performance based on women’s racial and ethnic group, with the hypothesis that diagnostic mammography differences may be related to differences seen at the time of diagnosis. The study included 267,868 digital diagnostic mammograms conducted among women who identified as non-Hispanic White (70%), non-Hispanic Black (13%), Asian/Pacific Islander (10%) and Hispanic (7%). The performance statistics examined included cancer detection, assessment accuracy, and follow-up recommendations. Additionally, the researchers examined the characteristics of the breast cancers that were detected by diagnostic mammography. Overall, the study showed that there was variation in diagnostic performance across a number of the statistics examined. For example, the positive predictive value (PPV2), which measures the probability that a woman was diagnosed with breast cancer given that the diagnostic mammogram indicated a probability of cancer, was highest among non-Hispanic White women (27.8%) and lowest among Hispanic women (19.4%). False-positive biopsy recommendations were most common among Asian/Pacific Islander women (169.2 per 1,000 mammograms versus other groups, range 126.5 to 136.1). Short interval follow-up recommendations were most common among non-Hispanic Black women (31.0% versus other groups, range 16.6% to 23.6%). An exploratory analysis suggested that some differences were explained by adjusting for receipt of diagnostic ultrasound or magnetic resonance imaging (for cancer detection rate) and imaging facility (for short-interval follow-up recommendation and biopsy recommendation), but other performance disparities were unaffected by adjustment for patient or clinical characteristics.

The study’s main conclusion was that diagnostic mammography performance varies across racial and ethnic groups. This suggests that the population-level risks and benefits of diagnostic mammography and strategies for increasing breast cancer early detection while reducing false-positives may differ based on women’s race and ethnicity. The results also show the importance of including diverse populations in mammography studies to provide an accurate view of the population-level effects.

Nyante SJ, Abraham L, Bowles EJA, Lee CI, Kerlikowske K, Miglioretti DL, Sprague BL, Henderson LM, for the Breast Cancer Surveillance Consortium; Diagnostic Mammography Performance across Racial and Ethnic Groups in a National Network of Community-Based Breast Imaging Facilities. Cancer Epidemiol Biomarkers Prev 2022. doi: 10.1158/1055-9965.EPI-21-1379. [Link

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Posted by: Sarah Nyante