Addressing Disparities in Breast Cancer Screening: A Review

Black women are less likely to be referred for genetic counseling and testing than White women.6'7 The American College of Radiolo-gy (ACR) and Society of Breast Imag-ing (SBI) recommend that all women be assessed for breast cancer risk by age 30 to determine if screening earlier than age 40 is needed.8 Up-dates to and expansion of screening guidelines by the ACR have been effective in improving awareness in populations at elevated risk of breast cancer and in guiding screening and identification of patients. Black and Hispanic women, for example, experience disproportion-ate poverty, inadequate access to higher-quality healthcare, absence of or inadequate health insurance, and differences in utilization of screening mammography.14,15 Unequal access to and utilization of screening mammog-raphy often lead to delays in detection, diagnosis, and treatment, amplifying disparities in patient outcomes.16,17 In addition, calculators and models that assess and quantify lifetime risk for breast cancer may underestimate risk among racial and ethnic minority women and potentially discourage them from seeking enhanced screen-ing and/or active surveillance.18 Black and Hispanic women are less likely than White women to be up to date with screening recommendations and to receive timely follow-up on results of abnormal screening and diagnos-tic mammography.19 Lawson, et al, found that structural healthcare system factors had the greatest impact on time-to-biopsy among racial and ethnic groups. Compared with White women, Asian, Hispanic, and Black women were at increased risk of failing to receive a biopsy within 30 days of an abnor-mal screening mammogram;Black women had the highest and most persistent risk of diagnostic delays of 90 days or longer.20 Longer intervals between screening and diagnosis lead to declines in screening benefits and more advanced cancers at diagnosis.21 Insufficient Health Insurance Coverage Screening mammography benefit-ed from the Patient Protection and Affordable Care Act, which expanded mandatory health insurance cover-age for routine preventive services and prohibits cost sharing. [...]breast imaging specialists can engage in community outreach initiatives that "increase breast cancer awareness in underserved communities, identify high-risk women for risk-reduction strategies, and develop programs that assist women in navigating their breast care.