Patients fail to undergo follow-up breast imaging services, despite same-day availability

Some patients still fail to undergo follow-up breast imaging services, despite the availability of same-day options, according to new research published Tuesday. 

Image-guided biopsies and diagnostic mammograms are crucial after an initial screening. However, some facilities are unable to provide the necessary supplemental services at the same site during the same visit, experts write in Radiology. 

New research shows that, even when practices offer these options, patients still aren’t using them. Individuals in racial and ethnic minority groups, in particular, are less likely to receive same-day diagnostic imaging or biopsies, the study found.  

“Despite having similar availability of diagnostic breast imaging services, there were substantial differences in whether patients received some of these services by race and ethnicity and neighborhood-level socioeconomic status,” study author Marissa B. Lawson, MD, MS, with the University of Washington in Seattle, said in a Feb. 18 statement from the Radiological Society of North America, which publishes the journal. 

“Identifying and understanding the disparities in diagnostic breast imaging can facilitate the development of interventions that aim to close gaps in this care pathway and may ultimately improve breast cancer outcomes and patient satisfaction,” she added. 

The retrospective analysis pinpointed patients 40 to 89 who underwent screening mammography at one of 136 U.S. facilities during the decade ending in December 2020. Altogether, the study included a racially diverse cohort of over 1.1 million women (median age of 59) who underwent 3.5 million screening mammograms across six states. Race, ethnicity and socioeconomic status were not associated with the nearby availability of same-day, same-site diagnostic services. However, minority patients were less likely than their white counterparts to undergo same-day diagnostic services after an abnormal screening mammogram. 

About 66% of the screening facilities included in the study offered same-day diagnostic services. Out of 9.3% screenings resulting in an abnormal mammogram, over 265,000 were included in the analysis evaluating same-day follow-ups. Asian, black and Hispanic patients were less likely to receive same-day diagnostic services. Same for patients from low-income neighborhoods when compared to affluent geographies. Black patients also were less likely to undergo a same-day biopsy, the authors found. 

Experts speculated possible reasons why these disparities persist in the face of programs to improve access. Patients may be unable to stay on-site long enough to receive additional services the same day. Some may need to return to work or their children, while others face concerns about lost wages or extra costs for follow-ups. Patients also may require prior authorization or not know if these additional services are covered. 

“This study identifies opportunities to consider targeted education and interventions directed toward minority and low socioeconomic status populations to increase the use of available services,” Lisa A. Mullen, MD, an associate professor of radiology at Johns Hopkins, wrote in a corresponding editorial. “Providing same-day diagnostic imaging and/or biopsy is challenging for breast imaging centers and requires a shift in both mindset and workflow. Given the potential benefit of decreasing disparities in access to breast imaging care, breast imaging centers should consider not only increasing availability of same-day services but also optimizing operational workflows to facilitate same-day services. This includes patient and referring provider education, access to necessary examination orders, appropriate patient scheduling templates, adequate technologist and radiologist staffing to cover the uncertain volume of same-day patients and assisting patients in their understanding of out-of-pocket costs and insurance coverage.”