Racial Differences in Screening Eligibility by Breast Density After State-Level Insurance Expansion.

Area of Science:

• Radiology
• Oncology
• Public Health Policy

Background:

• Dense breast tissue increases the risk of false-negative mammograms.
• Supplemental screening may benefit women with dense breasts.
• Pennsylvania mandated insurance coverage for supplemental breast cancer screening.

Purpose of the Study:

• To assess the outcomes of Pennsylvania's law mandating insurance coverage for supplemental breast cancer screening.
• To evaluate eligibility and false-negative mammogram rates among Black and White women.

Main Methods:

• Cross-sectional study of 68,478 women (Black and White, aged 40-74) undergoing mammography.
• Analysis of eligibility for supplemental screening based on breast density and lifetime cancer risk.
• Comparison of false-negative mammogram rates between racial groups.

Main Results:

• Fewer Black women met eligibility criteria for supplemental screening compared to White women.
• The criteria demonstrated lower sensitivity for detecting false-negative mammograms in Black women.
• Using breast density alone for supplemental screening recommendations may lead to unnecessary magnetic resonance imaging referrals.

Conclusions:

• Pennsylvania's supplemental screening criteria have limited ability to identify women at risk for false-negative mammograms, particularly Black women.
• The criteria may not accurately reflect breast cancer risk in Black women, potentially exacerbating health disparities.
• Current supplemental screening guidelines may require re-evaluation to ensure equitable access and effectiveness for all women.