Racial and Ethnic Variation in Diagnostic Mammography Performance among Women Reporting a Breast Lump.

ABSTRACT

BACKGROUND: We evaluated diagnostic mammography among women with a breast lump to determine whether performance varied across racial and ethnic groups. METHODS: This study included 51,014 diagnostic mammograms performed between 2005 and 2018 in the Breast Cancer Surveillance Consortium among Asian/Pacific Islander (12%), Black (7%), Hispanic/Latina (6%), and White (75%) women reporting a lump. Breast cancers occurring within 1 year were ascertained from cancer registry linkages. Multivariable regression was used to adjust performance statistic comparisons for breast cancer risk factors, mammogram modality, demographics, additional imaging, and imaging facility. RESULTS: Cancer detection rates were highest among Asian/Pacific Islander [per 1,000 exams, 84.2 (95% confidence interval (CI) 72.0-98.2)] and Black women [81.4 (95% CI 69.4-95.2)] and lowest among Hispanic/Latina women [42.9 (95% CI 34.2-53.6)]. Positive predictive values (PPV) were higher among Black [37.0% (95% CI 31.2-43.3)] and White [37.0% (95% CI 30.0-44.6)] women and lowest among Hispanic/Latina women [22.0% (95% CI 17.2-27.7)]. False-positive results were most common among Asian/Pacific Islander women [per 1,000 exams, 183.9 (95% CI 126.7-259.2)] and lowest among White women [112.4 (95% CI 86.1-145.5)]. After adjustment, false-positive and cancer detection rates remained higher for Asian/Pacific Islander and Black women (vs. Hispanic/Latina and White). Adjusted PPV was highest among Asian/Pacific Islander women. CONCLUSIONS: Among women with a lump, Asian/Pacific Islander and Black women were more likely to have cancer detected and more likely to receive a false-positive result compared with White and Hispanic/Latina women. IMPACT Strategies for optimizing diagnostic mammography among women with a lump may vary by racial/ethnic group, but additional factors that influence performance differences need to be identified. See related In the Spotlight, p. 1479.