Bridging the Digital Gap for Breast Cancer Screening

While radiologists update their practices with new technology, a study published August 30 in Radiology Business suggests that breast cancer screening locations should continue their non-digital channels — for appointment scheduling, participation in community health programs, as well as maintaining mobile mammography screening in mobile settings close to where patients reside.

The study led by corresponding author Peter Abraham, MD, of UC-San Diego, along with senior author Anand Narayan, MD, PhD, of the University of Wisconsin, examined 7,255 survey responses from women, who had no history of breast cancer, and who participated in the 2018 National Health Interview Survey (NHIS).

Their findings suggested that despite the efforts to broaden outreach via new technology, including patient portals and phone apps, that non-electronic forms of communication must continue — not due to computer illiteracy so much as persistent and historic gaps in access to healthcare and available resources.

Within this large cohort of women, only 18% (1,197) indicated that they’d make a clinical appointment using their computer. The demographic composition of these women was not surprising:

• Younger than average
• More educated
• Higher than average income
• White race
• More likely to be employed, have health insurance and be married

And there’s more — women who used their computers for scheduling clinical appointments also used their computers for filling prescriptions, researching healthcare, communicating with providers, and regularly attending to annual mammography screenings.

Abraham and the co-authors observed the irony that while increasing digital health has been perceived to be a method to expand healthcare, the reality is that these efforts exacerbate socioeconomic disparities. The co-authors noted, “Radiology practices and healthcare leaders must collaborate better with underserved communities to co-create feasible and scalable digital interventions.”

The study authors also note that the COVID-19 pandemic accelerated the growth of digital assets in healthcare, especially in telehealth and patient portals.

Individual healthcare entities should continue paper-based scheduling and allow patients to schedule appointments by phone to help bridge the digital gap that the co-authors uncovered.

Every local community and healthcare entity, plus the U.S. healthcare system as a whole, need to consider these recommendations to help maintain and expand access to healthcare in underserved populations.

• Increase access to broadband internet services.
• Identify internet coverage gaps.
• Offer broadband and smartphone device subsidies.
• Provide digital-driven literacy programs in conjunction with appointing digital navigators.
• Offer “linguistically and culturally concordant” web portals.
• Locate telehealth access points in assessable/appropriate locations.

Abraham observes, “Despite this potential, the development of digital tools may exacerbate existing disparities due to lower rates of technology adoption among underserved populations.”