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Addressing disparities in 3D mammo access

by Gus Iversen, Editor in Chief | July 06, 2021
Women's Health
From the July 2021 issue of HealthCare Business News magazine

Over the last several years, an abundance of research has illustrated the diagnostic advantages of 3D mammography, or digital breast tomosynthesis (DBT), over conventional 2D mammography for breast cancer screening, particularly for women with dense breast tissue. Unfortunately, the patients poised to benefit most from the scan are not always the ones receiving it, and disparities in access to 3D mammo may reflect larger inequities in healthcare.

Dr. Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise (NW SCORE), and professor of radiology and adjunct professor of health services at University of Washington School of Medicine, has studied 3D mammo utilization trends. We spoke to him to learn more about the problem and how to solve it.

Dr. Christoph Lee
HCB News: Earlier this year, you published research looking at access to 3D mammography across different demographics. Can you summarize your findings for us?
Dr. Christoph Lee: We found that in 2,313,118 screening exams performed across 92 Breast Cancer Surveillance Consortium (BCSC) facilities, women of minority race/ethnicity and lower socioeconomic status experienced lower DBT access during the early DBT adoption period (5.5% of Asian American, 6.6% of Black, and 10.0% of Hispanic versus 24.0% of white women in 2013), and persistently lower DBT use even when it was available at the time of imaging five years after facility-level adoption (58.0% of Black women versus 77.2% of white women; 66.9% of those with below high school education versus 87.3% of college graduates.

Overall, we concluded that women of minority race/ethnicity, lower education, and lower income experience lower DBT screening access and/or use, especially during the early technology adoption period, suggesting potential widening in persistent breast cancer screening disparities.

HCB News: Does your research point to any explanations for the disparities you found?
CL: While a majority of mammography facilities in the U.S. now offer DBT screening on at least one of their mammography units, less than half of all certified mammography units in the U.S. are DBT capable. That means that many women may not have access to DBT at their usual place of service. One major driving force for disparities in access to DBT screening is the fact that chronically lower-resourced settings may be the last to obtain this new technology.

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