Beyond the AJR: Racial and Ethnic Disparities in the Timeliness of Biopsy After Abnormal Screening Mammography

Lawson et al. [1] investigated the association between differences in time to follow-up from an abnormal screening mammogram result to biopsy among different racial and ethnic groups. The authors used prospectively collected data from seven registries of the Breast Cancer Surveillance Consortium, a large, diverse national cohort aimed at facilitating research to help improve breast cancer screening quality and patient outcomes [2]. They included 46,185 screening mammograms that were interpreted as abnormal and for which breast biopsy was recommended (i.e., BI-RADS category 4 or 5). The primary outcome of the study was the risk of having no biopsy performed within 30, 60, or 90 days of an abnormal screening mammogram [1]. The investigators excluded studies from facilities with less than 75% capture of biopsy results, studies with participants younger than 40 years or older than 79 years, and studies missing self-reported race or ethnicity. The results of the study showed that among the screening mammograms interpreted as abnormal with a subsequent biopsy recommendation, the percentage of cases not resolved was 34.6% at 30 days, 16.2% at 60 days, and 12.2% at 90 days [1]. The study also revealed that compared with White women, Asian, Black, and Hispanic women had higher risk of having no biopsy at 30 and 60 days. Additionally, Black women had higher risk of no biopsy at 90 days. The authors found that compared with individual-level and neighborhood-level factors, adjusting for screening facility resulted in the largest attenuation of risk of no biopsy. For Black women, the increased risk of no biopsy was reduced but not eliminated by adjusting for facility.