Social factors can lead to delays between breast imaging and biopsy

2021 03 05 17 52 1771 Patient Cancer Doctor 400

Women negatively affected by "social determinants of health" tend to experience delays between diagnostic breast imaging and biopsy, according to research published January 18 in the Journal of the American College of Radiology.

Left unaddressed, social factors such as housing or food insecurity or access to transportation can translate to poorer breast cancer outcomes, wrote a team led by Dr. Kevin Dao from Boston University School of Medicine.

"There is an importance of capturing SDH [social determinants of health] in radiology encounters, given their ubiquitous downstream effects on a patient's imaging journey," Dao and co-authors wrote. "[We] believe identifying SDH associated with longer lapses between imaging and biopsy is essential to early-stage detection of breast cancer, which in turn has a significant impact on survival."

Previous studies have suggested links between SDH and the quality of health outcomes for patients. But literature that explores the direct impact of these social determinants on delays in breast cancer diagnosis is limited, the investigators noted.

Dao's team explored this association via a study that included 2,885 women who underwent 3,142 diagnostic imaging studies between 2015 and 2020 and were then recommended to biopsy due to breast findings categorized as BI-RADS 4 or 5. The investigators considered the women's demographic data and focused on SDH variables such as food insecurity, housing insecurity, ability to pay for medications, transportation access, ability to pay for utilities, caretaking needs, employment, and desire for more education.

The researchers found that women experiencing at least one SDH factor was significantly associated with a longer lapse between imaging and biopsy (p = 0.048). Women with housing insecurity had near-association to longer lapses (p = 0.059), while women who wanted more education had shorter lapses (p = 0.037).

Understanding how particular social factors affect women's healthcare service uptake is key to improving care, according to Dao's group.

"Identification of which social determinant of health might affect the time from imaging to biopsy can potentially inform targeted programs to intervene," the team concluded. "Government and health system interventions addressing social determinants of health, notably housing insecurity, could allow for shorter times to breast cancer diagnosis and treatment."

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