Patient Diversity in Breast Imaging: Barriers and Potential Solutions

Abstract

Recent reports have highlighted disparities in breast cancer care related to patient diversity. Breast radiologists represent the face of breast imaging and are key players in advocating for patients to reduce these disparities. Diversity-related barriers for breast imaging patients, as they journey from screening to survivorship, include impediments to access and quality of care, gaps in communication, and lack of knowledge in both providers and patients. Potential strategies for overcoming these specific barriers include “culturally tailored” nurse navigators, mobile mammography, improved communication, patient and provider education, and breast radiologist involvement in advocacy efforts promoting diversity. As current trends in recommendations and guidelines for breast imaging include more numerous and advanced imaging modalities, it is important to acknowledge and address diversity-related disparities.

Disparities in the use of screening breast magnetic resonance imaging persist in Louisiana after the Affordable Care Act: A question of access, policy, institutional support, or something else?

“…Under the ACA, in an effort to make preventative health care services such as breast cancer screening accessible to all Americans, Medicaid and most private health insurance plans are required to provide coverage for mammograms without cost‐sharing 19 . To specifically address the unique heath needs of women, the Women’s Preventative Services Initiative guidelines, supported by the Health Resources and Services Administration, provide comprehensive recommendations of services to be covered: Breast MRI is not included in these recommendations 17…”

“…There are many barriers contributing to the lack of breast MRI screening in medically underserved minority communities; these include access to quality care, knowledge gaps, and challenges in communication 19 . Here we focus on three action items that we think would make the greatest impact for high‐risk Black women in our Louisiana communities: Reduce the high cost of breast MRI and lobby for ACA inclusion of breast MRI. Increase the ability of providers to identify women who might benefit from breast MRI. Improve patient education and reduce patient–provider communication gaps. …”

“…Patient navigators, acting as patient advocates, have proven highly successful in improving breast screening in general; navigators increase breast cancer screening rates, decrease follow‐up times, and increase patient satisfaction 19 ,. 23 Culturally tailored patient navigators have the potential to be highly effective in removing barriers to breast MRI screening; tailored navigators can help to overcome community‐specific communication barriers, particularly when follow‐up imaging and/or biopsy is required 19 . Community‐level breast imaging departments should strongly consider the use of culturally tailored patient navigators to improve communication and patient education during screening breast MRI.…”

“…Under the ACA, in an effort to make preventative health care services such as breast cancer screening accessible to all Americans, Medicaid and most private health insurance plans are required to provide coverage for mammograms without cost-sharing. 19 To specifically address the unique heath needs of women, the Women's Preventative Services Initiative guidelines, supported by the Health Resources and Services Administration, provide comprehensive recommendations of services to be covered: Breast MRI is not included in these recommendations. 17 After the institution of the ACA, a 2017 observational study looking at cost-sharing associated with screening breast MRI before and after ACA found a statistically significant trend of increasing outof-pocket (OOP) costs, with the proportion of zero cost-sharing claims decreasing from 43.1% in 2009 to 26.2% in 2017.…”

“…There are many barriers contributing to the lack of breast MRI screening in medically underserved minority communities; these include access to quality care, knowledge gaps, and challenges in communication. 19 Here we focus on three action items that we think would make the greatest impact for high-risk Black women in our Louisiana communities:…”