Ethnicity and Race Linked to Delays in Follow-ups for Mammograms

Black, Hispanic, and Asian women are almost one-and-a-half times more likely than white women not to follow-up on mammograms considered incomplete by the BI-RADS scoring system.

The BI-RADS scoring system provides radiologists with a shared, standardized terminology to use as they describe and classify their findings. The system gives a score of 0 for exams considered incomplete because the patient needs to return for additional imaging. The National Breast and Cervical Cancer Early Detection Program recommend that patients return promptly so that potential malignancies are discovered within a 60-day window, from screening to diagnosis. In those patients where malignancy is confirmed, reducing the time frame for diagnosis lessens the risk of progression.

A study led by Dr. Samantha Platt from Mount Sinai looked retrospectively at 5,034 individuals ages 40 to 91 from many breast centers in New York City. These patients had BI-RADS incomplete scores between March 19, 2018, and March 19, 2020. Each person finished a standard electronic clinical intake form assessing sociodemographic characteristics. The variables, which were self-reported included:

• Age
• Race
• Ethnicity
• Parity
• BRCA status
• Individual’s choice of written language for the questionnaire

Of the 5,034 screening mammograms, 446 individuals were excluded due to the screening site being a mobile mammography van, and 36 were excluded due to incorrect follow-up data. Of the 4,552 individuals included in the study, 904 (19.9%) had no follow-up.

The remaining 3,648 (80.1%) individuals completed a follow-up exam as follows:

• 2,797 (76.7%) individuals completed their exam within 60 days — with a median of 20.2 days
• 851 (23.3) individuals completed their follow-up exam beyond the 60 days — with a median of 175.9 days.

Racial/Ethnic Backgrounds Affecting Follow-up for BI-RADS 0 Mammograms

Racial/Ethnic Background	Odds Ratio	P-Value
White	1 being reference	N/A
Black	1.64	< 0.0001
Other	1.45	0.005
Asian	1.43	0.022
Hispanic	1.05	0.693
Not reported	2.13	< 0.0001

 

Hispanic women were the most likely to either have no follow-up or >60-day follow-up. The study group observed that women who answered their questionnaire in English rather than Spanish had shorter median follow-up times. The individuals who answered in Spanish were likelier not to have any follow-up.

Researchers learned that women with a known BRCA mutation had a significantly shorter median follow-up period — 22 days versus 27 days.

Pratt and her study team members found that age, parity, or Tyrer-Cuzick score did not significantly change follow-up time.

A delay in follow-up for an abnormal screening mammogram places patients at risk for a progression of disease. The study’s goal was to discover the factors linked with no follow-up or delay in follow-up so that these obstacles can be removed or reduced to improve health outcomes.

Previous studies have shown that lack of access to care is a contributing factor. Pratt’s team hypothesizes that difficulties in accessing care continue to plague women of ethnic and racial diversity. Another study found that non-English speaking Hispanic women experienced an average delay of five or six months for diagnostic imaging — potentially leading to worse outcomes for these individuals.

Some breast imaging centers now provide patient navigators to help patients with appointment scheduling, patient education, transportation arrangement, and emotional support. Programs like these have shown improvements in follow-up times and patient experience, and further study is needed to help eliminate these disparities.