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. 2023 Nov 1;32(11):1542-1551.
doi: 10.1158/1055-9965.EPI-23-0289.

Racial and Ethnic Variation in Diagnostic Mammography Performance among Women Reporting a Breast Lump

Sarah J Nyante  1   2 , Linn Abraham  3 , Erin J Aiello Bowles  3 , Christoph I Lee  4   5   6 , Karla Kerlikowske  7 , Diana L Miglioretti  3   8 , Brian L Sprague  9 , Louise M Henderson  1   2 ; Breast Cancer Surveillance Consortium
Affiliations

Racial and Ethnic Variation in Diagnostic Mammography Performance among Women Reporting a Breast Lump

Sarah J Nyante et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: We evaluated diagnostic mammography among women with a breast lump to determine whether performance varied across racial and ethnic groups.

Methods: This study included 51,014 diagnostic mammograms performed between 2005 and 2018 in the Breast Cancer Surveillance Consortium among Asian/Pacific Islander (12%), Black (7%), Hispanic/Latina (6%), and White (75%) women reporting a lump. Breast cancers occurring within 1 year were ascertained from cancer registry linkages. Multivariable regression was used to adjust performance statistic comparisons for breast cancer risk factors, mammogram modality, demographics, additional imaging, and imaging facility.

Results: Cancer detection rates were highest among Asian/Pacific Islander [per 1,000 exams, 84.2 (95% confidence interval (CI): 72.0-98.2)] and Black women [81.4 (95% CI: 69.4-95.2)] and lowest among Hispanic/Latina women [42.9 (95% CI: 34.2-53.6)]. Positive predictive values (PPV) were higher among Black [37.0% (95% CI: 31.2-43.3)] and White [37.0% (95% CI: 30.0-44.6)] women and lowest among Hispanic/Latina women [22.0% (95% CI: 17.2-27.7)]. False-positive results were most common among Asian/Pacific Islander women [per 1,000 exams, 183.9 (95% CI: 126.7-259.2)] and lowest among White women [112.4 (95% CI: 86.1-145.5)]. After adjustment, false-positive and cancer detection rates remained higher for Asian/Pacific Islander and Black women (vs. Hispanic/Latina and White). Adjusted PPV was highest among Asian/Pacific Islander women.

Conclusions: Among women with a lump, Asian/Pacific Islander and Black women were more likely to have cancer detected and more likely to receive a false-positive result compared with White and Hispanic/Latina women.

Impact: Strategies for optimizing diagnostic mammography among women with a lump may vary by racial/ethnic group, but additional factors that influence performance differences need to be identified. See related In the Spotlight, p. 1479.

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Conflict of interest statement

Conflict of Interest Disclosures:

Nyante: No conflicts of interest to disclose.

Abraham: No conflicts of interest to disclose.

Bowles: No conflicts of interest to disclose.

Lee: Personal fees from GRAIL, Inc. for service on data safety monitoring board; textbook royalties from McGraw Hill, Oxford University press, Wolters-Kluwer; personal fees from the American College of Radiology for Journal of the American College of Radiology Deputy Editor duties.

Kerlikowske: Non-paid consultant with Grail on the STRIVE study.

Miglioretti: Textbook royalties from Elsevier.

Sprague: No conflicts of interest to disclose.

Henderson: No conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Diagnostic mammogram inclusion criteria.
This study included digital diagnostic mammograms performed at an imaging facility affiliated with the Breast Cancer Surveillance Consortium (BCSC) among women who reported a breast lump. Eligible mammograms were performed between 2005 and 2018 and did not have another diagnostic mammogram in the preceding 90 days.
See this image and copyright information in PMC

Comment in

References

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