Sources of Disparities in Surveillance Mammography Performance and Risk-Guided Recommendations for Supplemental...

Area of Science:

• Oncology
• Radiology
• Health Equity

Background:

• Surveillance mammography is standard for breast cancer survivors.
• Risk-guided surveillance using advanced imaging could enhance early detection of second cancers.
• Personalized screening approaches may inadvertently widen existing health disparities.

Purpose of the Study:

• To investigate race- and ethnicity-based disparities in risk-guided breast cancer surveillance.
• To analyze how cancer characteristics and social determinants of health (SDOH) contribute to these disparities.
• To assess the impact of personalized surveillance on mammography performance and supplemental imaging recommendations.

Main Methods:

• Simulated populations based on Breast Cancer Surveillance Consortium (BCSC) data (65,446 mammograms).
• Modeled disparities by varying race/ethnicity in cancer characteristics, SDOH, and ascertainment error.
• Estimated effects on mammography sensitivity, specificity, and supplemental imaging recommendations.

Main Results:

• Mammograms for Black women showed lower sensitivity (64.1%) compared to the general population (71.1%) when only cancer characteristics varied by race/ethnicity.
• Disparities in sensitivity widened when both cancer characteristics and SDOH varied (53.8% vs. 71.1%).
• Risk-based supplemental imaging recommendations were less frequent for Hispanic (6.7%) and Asian/Pacific Islander (6.4%) women compared to the overall population (10.0%).

Conclusions:

• Disparities in surveillance mammography performance and supplemental imaging recommendations are linked to variations in cancer characteristics and SDOH.
• Implementing risk-guided surveillance may exacerbate existing inequities.
• Careful consideration of equity implications is crucial for risk-guided screening programs.