By Arianna Einjelika Abalos
NORTHWEST ASIAN WEEKLY
A new University of Washington (UW) retrospective study spanning 11 years reveals that even though Asian patients have the same access to different diagnostic technologies as white patients, Asian patients often do not receive same-day diagnostic follow-ups, following an abnormal mammogram.
The same is true for patients of other races, including Black and Hispanic patients, and patients of lower educational attainment and fewer financial means, the study found.
The speed at which a patient receives follow-up diagnostics and care can be the factor that determines whether they recover from a detected breast cancer, and delaying any follow-up can “set off a chain reaction of delays,” Dr. Marissa Lawson, the study’s lead author and assistant professor of radiology at the UW’s Breast Imaging Department, said.
Breast cancers can progress differently, depending on the stage. According to a 2018 study, “Half of breast cancers exhibit rapid growth, one-third grow at an intermediate rate, and 15% grow slowly.”
However, the severity of the cancer differs between patients, which can mean an expedited progression in a shorter amount of days.
“I think I’m mostly worried when patients have these long delays especially, when we see that patients are not coming back for diagnostic imaging for 90 days,” Lawson said. “If [the mammogram is] abnormal, [it’s] pushing out a new biopsy even further, and based on some of the data we’ve seen, 90 days makes a difference in those longer term outcomes.”
Lawson and her fellow researchers looked at data from a total of 1.1 million women in the Breast Cancer Surveillance Consortium breast imaging registries in six different states. Together, the women had a combined total of 3 million screenings.
Of the patients studied, 10.3% were Asian, 12.7% were Black, 6.5% were Hispanic, 68.3% were white, and 2.2% represented all other races.
The study found that although most facilities offer the diagnostic and biopsy services recommended after an abnormal mammogram, there were still racial and socioeconomic disparities in the timing of their appointments for these services.
There was not much variability between race and ethnicity in the availability of diagnostic or biopsy services at the same places the patients’ received their mammograms. However, Asian, Black, and Hispanic patients, as well as patients in neighborhoods with lower educational attainment and patients in neighborhoods with lower income, received fewer diagnostic services after screening mammography after 90 days.
For same-day diagnostic services, Asian, Black, and Hispanic patients received fewer same-day diagnostic services compared to white patients.
For same-day biopsies, Black patients were less likely to undergo a same-day biopsy than white patients, and those of middle income were less likely to undergo same-day biopsies than high income.
There are several factors at play, when it comes to receiving follow-up care, researchers found.
Researchers found that rural patients were more likely to receive same-day diagnostic care than those who lived in urban environments, due to commute times. But even if offered, same-day care can still be considered a deterrent, because of the uncertainty in the time it may take: Patients may need to plan around an unexpected same-day test, following a mammogram, which may cut into other responsibilities such as child care.
Cost is another factor, as some costs may not be covered by insurance, so patients may have to pay out-of-pocket—or can’t afford to pay out-of-pocket at all. Scheduling more convenient appointments can also take weeks, which lengthens the duration between screening, diagnosis, and treatment.
Lawson encouraged patients to ask questions about their treatment, to maximize its effectiveness.
“I encourage patients to ask about the timing of the biopsy and even when they’re making appointments,” Lawson said.
Several clinics, including the UW’s, also offer a variety of services to ease patient burden in arranging appointments and understanding the financial terms of their care. Some clinics also offer rideshare vouchers and expanded appointment slots.
Still, Lawson acknowledged, workforce resources are spread thin, even as patient volume increases, following guidance from the U.S. Preventative (Services) Task Force, Lawson said.
“Access is just a problem overall in our area,” Lawson said.