Non-Hispanic Black women were most likely to receive a false-negative report. The false-negative rate per 1,000 mammograms was 4.6 for Blacks, 4.0 for whites, 3.3 for Asian/Pacific Islanders, and 2.6 for Hispanics.
Non-Hispanic Black women were the most likely to receive “short-interval follow-up recommendations,” with 31 percent of women recommended for further imaging within six months. By comparison, 22.1 percent of white women, 16.1 percent of Asian/Pacific Islander women, and 23.6 percent of Hispanic women received this recommendation.
There were also differences in the tumors detected through the diagnostic mammograms. Overall, Asian/Pacific Islander women had the largest proportion of ductal carcinoma in situ (DCIS), a noninvasive subtype. Meanwhile, Black women were more likely to be diagnosed with later-stage tumors and higher tumor grade. As previous research has shown, they were also more likely to be diagnosed with the aggressive triple-negative breast cancer subtype.
Nyante noted that controlling for patient-level characteristics did not explain the differences in performance statistics in this study, suggesting that the role of the diagnostic facility in women’s breast cancer treatment should be further studied. She added that this study underscores the importance of the inclusion of women from all backgrounds in clinical studies, so that the population-level risks and benefits of mammography can be more clearly understood.
“Examining differences in diagnostic digital mammography performance and tumor characteristic outcomes by race and ethnicity may help us understand why disparities in cancer detection and quality of care persists for some demographic groups,” Nyante said.
Nyante noted some limitations to the study. While the study included both full-field digital mammograms and digital breast tomosynthesis (DBT), DBT has become much more widely available in recent years. Therefore, the study findings may not be entirely generalizable to the current imaging industry.
This study was funded by grants from the National Cancer Institute, the Patient-Centered Outcomes Research Institute, and the Agency for Health Research and Quality. Nyante declares no conflicts of interest.
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