Disparities in Screening Mammography Services by Race/Ethnicity and Health Insurance

Background: Black and Hispanic women are diagnosed at a later stage of breast cancer than white women. Differential access to specialists, diffusion of technology, and affiliation with an academic medical center may be related to this stage disparity. Methods: We analyzed data from a mammography facility survey for the metropolitan region of Chicago, Illinois, to assess in part whether quality breast imaging services were equally accessed by non-Hispanic white, non-Hispanic black, and Hispanic women and by women with and without private insurance. Of 49 screening facilities within the city of Chicago, 43 facilities completed the survey, and 40 facilities representing about 149,000 mammograms, including all major academic facilities, provided data on patient race/ethnicity. Results: Among women receiving mammograms at the facilities we studied, white women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imaging specialists to read mammograms, and at facilities where digital mammography was available ( p < 0.001). Women with private insurance were similarly more likely than women without private insurance to have mammograms at facilities with these characteristics ( p < 0.001). Conclusions: Black and Hispanic women and women without private insurance are more likely than white women and women with private insurance to obtain mammography screening at facilities with less favorable characteristics. A disparity in use of high-quality mammography may be contributing to disparities in breast cancer mortality

Additional file 2: Table S2. of Preliminary evaluation of the publicly available Laboratory for Breast Radiodensity Assessment (LIBRA) software tool: comparison of fully automated area and volumetric density measures in a case–control study with digital mammography

Univariate logistic regression tables for absolute area, absolute volume, VD %, and BI-RADS breast density adjusted for both standard risk factors and BMI. BI-RADS Breast Imaging-Reporting and Data System, BMI body mass index, LIBRA Laboratory for Individualized Breast Radiodensity Assessment, N/A not applicable, VD % volume percent density. (PDF 213 kb

Additional file 1: Table S1. of Preliminary evaluation of the publicly available Laboratory for Breast Radiodensity Assessment (LIBRA) software tool: comparison of fully automated area and volumetric density measures in a case–control study with digital mammography

Univariate logistic regression tables for absolute area, absolute volume, VD %, and BI-RADS breast density adjusted for standard risk factors. BI-RADS Breast Imaging-Reporting and Data System, LIBRA Laboratory for Individualized Breast Radiodensity Assessment, N/A not applicable, VD % volume percent density. (PDF 207 kb

Supplementary Data from Imaging Phenotypes of Breast Cancer Heterogeneity in Preoperative Breast Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) Scans Predict 10-Year Recurrence

Supplementary data includes appendix of extracted Radiomic features. Figure S1 shows a summary of patient characteristics. Figure S2 shows the radiomic analysis workflow. Figure S3 shows representative cases from heterogeneity phenotypes. Figure S4 shows independent validation of intrinsic imaging phenotypes of tumor heterogeneity.</p

Participants in key informant interviews and focus groups by facility type.

Participants in key informant interviews and focus groups by facility type.</p

Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist.

Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist.</p

Barriers to optimal care for babies in newborn care units that highlight the impact of Covid-19.

Barriers to optimal care for babies in newborn care units that highlight the impact of Covid-19.</p

Inclusivity in global research.

Nearly one quarter (600,000) of all neonatal deaths worldwide per year occur in India. To reduce neonatal mortality, the Indian Ministry of Health and Family Welfare established neonatal care units, including neonatal intensive care units and specialized neonatal care units to provide immediate care at birth, resuscitation for asphyxiation, postnatal care, follow up for high-risk newborns, immunization, and referral for additional or complex healthcare services. Despite these efforts, neonatal mortality remains high, and measures taken to reduce mortality have been severely challenged by multiple problems caused by the Covid-19 pandemic. In this qualitative study, we conducted seven focus group discussions with newborn care unit nurses and pediatric residents and 35 key informant interviews with pediatricians, residents, nurses, annual equipment maintenance contractors, equipment manufacturers, and Ministry personnel in the Vidarbha region of Maharashtra between December 2019 and November 2020. The goal of the study was to understand barriers and facilitators to providing optimal care to neonates, including the challenges imposed by the Covid-19 pandemic. Covid-19 exacerbated existing barriers to providing optimal care to neonates in these newborn care units. As a result of Covid-19, we found the units were even more short-staffed than usual, with trained pediatric nurses and essential equipment diverted from newborn care to attend to patients with Covid-19. Regular training of neonatal nursing staff was also disrupted due to Covid-19, leaving many staff without the skills to provide optimate care to neonates. Infection control was also exacerbated by Covid-19. This study highlights the barriers to providing optimal care for neonates were made even more challenging during Covid-19 because of the diversion of critically important neonatal equipment and staff trained to use that equipment to Covid-19 wards. The barriers at the individual, facility, and systems levels will remain challenging as the Covid-19 pandemic continues.</div