Radiology providers missing the mark when screening disabled women for breast cancer
Radiology providers appear to be missing the mark when delivering breast cancer screening services to women with disabilities.
This patient population already faces “substantial” disparities in cancer detection and treatment, resulting in poorer healthcare outcomes, experts detailed in JAMA Surgery. To better understand such challenges, researchers with NYU Langone Health reviewed records for women treated in 2023 and 2024 at a specialized clinic catered to this population.
They unearthed concerning results, with only about 43% of women with disabilities receiving American Society of Breast Surgeons-recommended mammography screening. That’s substantially lower than the 65% uptake seen in the general population. What’s more, these patients received “suboptimal care”—such as ultrasound screening without mammography—potentially due to “physical accessibility barriers that created challenges in positioning patients.”
“The findings of this cohort study were drawn from an urban clinic providing comprehensive women’s healthcare tailored to the needs of women with disabilities, suggesting that suboptimal rates of breast cancer screening and barriers to screening in the general population may be considerably higher,” NYU radiologist Samantha L. Heller, MD, PhD, and co-authors wrote Sept. 10. “Enhancing imaging accessibility and educating healthcare professionals about the needs of people with disabilities are essential steps toward improving screening uptake and reducing long-standing disparities.”
For the study, Heller et al. reviewed electronic health records for women treated at the Initiative for Women with Disabilities specialty clinic. They looked to ascertain the breast cancer screening rate for those eligible based on guidelines from the ASBS, which endorses annual screening starting at 40. Altogether, the analysis included 138 women who met the study’s criteria. About 83% required mobility accommodations and all but 1 were insured, with Medicare the most common payer (51%).
Only 59 patients (or 43%) received screening in accordance with ASBS guidelines, while 42% received no screening. The other 15% received what the authors deemed as “inadequate screening,” meaning they either underwent ultrasound instead of screening mammography (6%) or SM with suboptimal views (9%). Of the 72 women who had proper screening, 18% produced images with limited views for reasons such as wheelchair use or patient immobility. Patient refusal or “inability to tolerate the procedure” were the typical reasons for receiving ultrasound without screening mammography, the authors reported.
“Notably, most EHRs do not support documenting accommodations (e.g., mobility devices), which can lead to challenges in providing care even when these transfer devices are available,” Heller and co-authors noted. “Most patients in our study required mobility accommodations, but our own EHRs lack demographic information on disability type, which is a study limitation. Lack of documentation perpetuates barriers that reduce adherence to screening guidelines and recommendations.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.