Abstract PD1-02: Evaluating Racial and Ethnic Disparities in Diagnostic Breast Imaging: A Retrospective Cohort Study
Authors: Milton Arissa , Woods Ryan , Elezaby Mai , Neuner Joan , Hackett Kelly , Narayan Anand , Strigel Roberta 
Published: March 2023

Abstract
Purpose: The purpose of this study is to examine the association between race/ethnicity and diagnostic delays in patients with abnormal screening mammograms. Methods: HIPAA-compliant, institutional review board exempt retrospective cohort study was performed at a multi-location academic medical center located in the Midwest. Patients included women aged 40-74 years old undergoing screening mammography from 2013-2019 who received a Breast Imaging Reporting and Data System (BI-RADS) category 0 on their screening mammogram, derived from the electronic medical records. Primary outcome variables included timely follow up diagnostic imaging (&lt; 30 days), days to diagnostic exam, timely recommended biopsy (&lt; 60 days), and days to recommended biopsy. Primary exposure variables included race (American Indian/Alaska Native, Asian/Native Hawaiian/Other Pacific Islander, Black or African American, White) and ethnicity (Hispanic/Latino, and Not Hispanic/Latino). Binary outcomes (timely follow up diagnostic imaging, timely recommended biopsy) were analyzed using logistic regression and continuous outcomes (days to diagnostic exam, days to recommended biopsy) were analyzed using Cox proportional hazards regression, adjusted for potential confounders (insurance, age, preferred language, having primary care doctor, married or domestic partnership, availability of on-site diagnostic imaging). Results: 13,269 unique patients received BI-RADS category 0 on screening mammogram (mean age 54.6). Adjusted for potential confounders, Black (OR 0.54, 95% CI 0.42 to 0.69, p &lt; 0.001) and Asian (OR 0.62, 95% CI 0.45 to 0.85, p = 0.004) patients were less likely to have timely follow up diagnostic imaging compared to White patients. American Indian and Hispanic patients were comparably likely to have timely follow up diagnostic imaging (p &gt; 0.05). Black (HR 0.76, 95% CI 0.69 to 0.84, p &lt; 0.001), Asian patients (HR 0.78, 95% CI 0.70 to 0.87, p &lt; 0.001), and Hispanic patients (HR 0.90, 95% CI 0.82 to 0.99, p = 0.041) experienced increased days to diagnostic examinations compared with White patients. American Indian patients experienced comparable times to diagnostic examinations (p = 0.136). 22.3% of patients received recommendations for biopsy (2,796/12,535). No statistically significant differences were found in timely follow up after recommended biopsy (&lt; 60 days) comparing Black, Asian, American Indian, and Hispanic to White patients (p &gt; 0.05). Black, American Indian, and Hispanic patients experienced comparable days to recommended biopsy (p &gt; 0.05). Asian patients experienced increased days to recommended biopsy (HR 0.76, 95% CI 0.58 to 0.99, p = 0.046). Conclusions: Racial/ethnic minority patients are more likely to experience diagnostic delays after screening mammograms. Further research into culturally appropriate patient navigation services and improved accessibility of diagnostic imaging centers (operating hours, same day services, transportation, parking) to reduce disparities in diagnostic imaging delays is warranted.
Citation Format: Arissa Milton, Ryan Woods, Mai Elezaby, Joan Neuner, Kelly Hackett, Anand Narayan, Roberta Strigel. Evaluating Racial and Ethnic Disparities in Diagnostic Breast Imaging: A Retrospective Cohort Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD1-02.