Women of minority races and ethnicities and with less education and income have had relatively lower access to 3D mammography, a technology that can improve breast cancer detection and decrease false alarms, according to research published today.
"This study was about whether adoption of this technology is equitable. We're showing that it has not been, even though it has been FDA-approved for a decade now," said Dr. Christoph Lee, professor of radiology at the University of Washington School of Medicine. "Black and Hispanic women, and less-educated and lower-income women have not been able to obtain 3D mammography as easily as white, well-educated, and higher-income women."
Lee was lead author of the paper, published in JAMA Network Open.
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The research team reviewed 2.3 million breast-screening exams collected by the national Breast Cancer Surveillance Consortium, making it the largest-ever study of U.S. access to digital breast tomosynthesis (DBT), commonly called 3D mammography. In February 2011, the Food and Drug Administration approved DBT as an alternative to digital mammography, then the standard of care. Subsequent observational studies have shown that DBT is more accurate than digital mammography by detecting more cancers and yielding fewer false-positive readings.
This study included patients' screening exams from 92 imaging facilities across five states, and spanned January 2011 through December 2017. The researchers analyzed whether the facilities offered DBT onsite at the time of a screening exam, and compared the use of DBT and digital mammography across patient populations at those facilities.
"Given the large research sample and our longitudinal data collection, we were able to evaluate use by minority and traditionally underserved populations," said Diana Miglioretti, Ph.D., professor and division chief of biostatistics at the University of California Davis and senior author on the study. "Unfortunately we were not surprised to find that these traditionally underserved populations were less likely to attend facilities that offered 3D mammography, and even when they did, they were less likely to receive a 3D mammogram."
In 2011, only 3% of women in the study could access DBT at the time of their screening; by 2017, that figure had grown to 82%. Despite facilities' adoption of 3D technology over those seven years, the improved availability was not experienced equally.
When both 2D and 3D mammograms were available onsite at time of screening, DBT was obtained by: