Radiologists call for action to address ‘growing suburban-urban gap’ in breast cancer detection

Radiologists are calling for action to address a “growing suburban-urban gap” in breast cancer diagnosis and detection. 

Numerous studies have charted the COVID-19 pandemic’s outsized impact on imaging, with patient volumes dropping precipitously after shutdowns took effect. However, experts with Jefferson Health in Philadelphia have a new angle, exploring differences in how city radiologists were impacted compared to suburban counterparts. 

In 2020, screening mammogram volume dropped nearly 24% at urban sites compared to less than 2% outside the city. Meanwhile, diagnostic mammogram levels fell 26% at metropolitan locations versus 21% in suburbs. Recovery levels have remained uneven since then, necessitating changes in response to this issue, experts wrote Friday in Clinical Imaging. 

“Targeted interventions in urban communities such as increased outreach, community education, and resource allocation are essential to bridge the growing urban-suburban gap in breast cancer detection and diagnosis,” Sarah J. Ciccarelli, MD, who practices with the Lehigh Valley Hospital–Cedar Crest in Allentown, Pennsylvania, and colleagues concluded. “Further, enhancing the resilience of healthcare systems to navigate future public health crises is an equally pressing priority and stresses the need for strategic planning and policy interventions to fortify the healthcare infrastructure and ensure its adaptability in the face of unforeseen challenges across all types of communities.”

Researchers analyzed data from the single institution, which operates 18 hospitals and over 40 outpatient care locations across Philadelphia and its suburbs. By 2021, breast cancer screening volumes at urban sites were about 3% greater than pre-pandemic levels compared to 31% at suburban sites. Conversely, diagnostic mammography volumes were still 29% below pre-pandemic levels in the city and 17% lower outside of Philadelphia. That same year, the proportion of invasive ductal carcinoma at urban sites leapt by over 26%, Ciccarelli and colleagues reported.

“The pattern strongly suggests stage migration in our urban population toward more invasive cancer, which is most likely related to the profound disproportionate decline in screening and diagnostic services seen in this population during the pandemic,” they wrote.  

By 2022, there were signs of progress, with screening volumes at all sites surpassing pre-COVID numbers by almost 20%. However, diagnostic volumes remained 22% lower. 

Language barriers, affordability, and lack of insurance and transportation all may have fueled these disparities, the authors added. This urban-suburban divide occurred, despite Jefferson diverting resources away from suburban sites to focus on its main hospital hub in the city. Experts called for measures to address the social determinants of health, along with other possible responses.

“Recognizing the critical role of radiologists in the diagnostic process, strategies to address shortages in this workforce are also paramount to restoring and maintaining comprehensive breast healthcare,” the authors advised. “We must turn our attention not only toward disadvantaged communities in the present to mitigate the long-term consequences of the COVID-19 pandemic but also toward the future to build equitable infrastructure that better serves all our patients.”