ASPO Abstracts
Urban and Rural Mammography Facility Responses to the NC Breast Density Legislation
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose: We sought to evaluate if rural and urban mammography facilities differ in their response to the 2014 NC breast density legislation.Methods: In 2017, we used the Tailored Design Approach to conduct a mailed 50-item survey to 156 NC American College of Radiology certified mammography facilities. The survey included questions about facility demographics, supplemental breast cancer screening services, and referral patterns. Using regression weight adjustments to account for non-response, we explored whether the legislation was being implemented differently based on facility urban-rural classification using t-tests and chi-square tests.Results: Overall, 94 mammography facilities responded (60.3% response rate). Facilities were 51% rural and 49% urban. Approximately 59% of rural and 69% of urban facilities reported offering supplemental breast cancer screening. A similar proportion of rural and urban facilities offered supplemental screening with digital breast tomosynthesis (DBT) (52.7% and 63.3%); however, more urban than rural facilities offered breast magnetic resonance imaging (MRI) (30.6% vs. 4.5%; p-value <0.001) and handheld ultrasound (25.5% vs. 15.7%; p-value=0.072). More urban than rural facilities base supplemental screening on patient breast density (57.4% vs. 32.8%; p-value <0.001), patient risk factors (62.8% vs. 26.3%; p-value <0.001) and referring physician recommendation (78.2% vs. 47.7%; p-value <0.001). In contrast, both urban and rural facilities reported similar supplemental screening based on patient request (41.0% and 45.3%) and reading radiologist recommendation (74.5% and 62.9%). All facilities report breast density findings in the patient result letter, but urban facilities were more likely to also report density findings in the final radiology report that is sent to the referring physician (76.3% vs. 58.7%; p-value=0.004).Conclusions: Urban facilities were more likely to offer supplemental screening services beyond DBT, such as breast MRI and handheld ultrasound; such differences may impact urban-rural breast cancer disparities. Communication between facilities, radiologists and referring providers is needed to allow for discussion of and if desired, referral to specific imaging modalities for women with dense breasts.
Keywords: breast cancer supplemental screening; breast density; breast density legislation