Food, housing insecurity tied to breast biopsy delay

By Theresa Pablos, AuntMinnie staff writer

November 19, 2020 -- Women with food and housing insecurity experience a delay between receiving a BI-RADS 4 or 5 result on diagnostic breast imaging and a subsequent biopsy. The finding is part of a paper on the effects of unmet social needs on imaging that will be presented at the virtual RSNA 2020 meeting.

Prior studies have shown that social determinants of health, such as access to secure housing, food, and transportation, can impact health outcomes. In the new analysis, a research team from Boston showed that these determinants can also affect timely breast imaging.

Aaron Afran
Aaron Afran. Image courtesy of the RSNA.

"Our goal with this study was to understand how social determinants of health influence the time interval between breast imaging and follow-up appointments," stated presenter Aaron Afran, a third-year medical student at Boston University School of Medicine, in a press release.

For their analysis, Afran and colleagues used data from 2,322 patients who underwent breast imaging at Boston Medical Center between 2015 and 2018. The medical center is a safety-net facility, and the majority of the women in the study identified as Black (56%).

In the analysis, housing and food insecurity were both independently and significantly associated with a delay between diagnostic imaging and biopsy. The two factors were also tied to a delay after screening mammography, although the findings didn't reach significance.

"It could be that food and housing insecurity become so impactful that imaging appointments may become a lower priority," Afran said in a recording of the presentation.

While food and housing were tied to longer delays, the opposite was true for some other social needs. In fact, facing a transportation barrier was associated with significantly less time between diagnostic imaging and biopsy. Patients experiencing at least one social barrier of any kind also had a significantly smaller delay.

Afran attributed the unexpected transportation finding to the availability of rideshare vouchers and similar programs for patients at the Boston Medical Center. The transportation finding could also impact the interpretation of other data.

"We think that transportation may actually be masking the effect of other social determinants of health," Afran said.

It's still unclear what impact the new findings could have on clinical care and patient outcomes. Importantly, the mean delay between diagnostic imaging and biopsy was only 1.5 days -- a time frame that Afran said has "uncertain clinical significance." At the same time, however, the pandemic has contributed to millions of Americans facing food and housing insecurity.

The next step for the research team is to conduct studies with longer time frames and more data, Afran said. The team also intends to analyze the impact of interventions as well as any correlation between these findings and clinical outcomes, such as survival.

"Our findings indicate longer lapses between diagnostic imaging and biopsy for patients with unmet social needs, which begs the question: Are unmet social needs associated with some amount of breast cancer mortality that could have been prevented?" stated Dr. Michael Fishman, sections chief of breast imaging at Boston Medical Center. "We seek to investigate this in future work."


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