Disparities in Breast Cancer Outcome and Screening

Hi, I'm Soudabeh Fazeli. I'm an assistant professor of breast imaging at the Department of Radiology of UC San Diego Health, and I'm going to talk about disparities in breast cancer outcome and screening. I have no disclosures.

Objectives

  • Discuss the effectiveness of screening mammography in early detection of breast cancer.
  • Examine the persistent disproportionate burden of breast cancer morbidity and mortality among certain populations.
  • Break down disparities into different categories and understand their interrelation.

Topics and Summaries

Racial and Ethnic Minorities

Racial minorities, particularly Black and Hispanic women, face higher breast cancer mortality rates compared to non-Hispanic White women. Factors include lower screening mammography use, delayed diagnosis, and advanced stages of breast cancer at diagnosis. Screening recommendations are based on evidence from non-Hispanic White women, not accounting for the younger age and advanced stage diagnosis in racial minorities.

Insurance Status

Insurance status affects access to quality breast cancer imaging. Private insurance is a strong predictor of screening mammography use. Lack of adequate health insurance leads to disparities in access to advanced technologies and fellowship-trained radiologists, contributing to late-stage diagnoses.

Geographic Access

Women in rural or underserved communities face challenges accessing breast imaging facilities. Black and Hispanic women are more likely to live in these areas, exacerbating disparities in breast cancer outcomes.

Immigrant Populations

Immigrant women encounter unique barriers to breast imaging, including cultural beliefs and language proficiency. Culturally tailored approaches, such as religiously tailored workshops, can improve screening adherence.

Gender Minority Populations

Transgender women who receive hormonal therapy are at increased risk for breast cancer. There is a need for more prospective studies to guide screening guidelines for transgender women.

Age 75 and Older

Screening mammography benefits versus harms in women aged 75 and older is controversial due to a lack of evidence. Guidelines recommend individualized screening decisions based on health and life expectancy.

Digital Breast Tomosynthesis (DBT)

DBT improves screening and diagnostic outcomes but is less accessible to racial minorities and women of lower socioeconomic status. Disparities in DBT use can worsen existing disparities in breast cancer outcomes.

Impact of COVID-19 Pandemic

The pandemic led to a significant decline in screening mammograms, with a disproportionate impact on racial minorities. This raises concerns about worsening disparities in breast cancer outcomes.

Conclusion

Screening mammography saves lives, but disparities in breast cancer screening and outcomes persist. The pandemic may have further worsened these disparities. It is crucial for radiologists to recognize and address these disparities to improve breast cancer outcomes for all populations.

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