Potentially missed detection with screening mammography: does the quality of radiologist's interpretation vary by patient socioeconomic advantage/disadvantage?

Ann Epidemiol. 2013 Apr;23(4):210-4. 
Authors: Rauscher GH, Khan JA, Berbaum ML, Conant EF.

From the accepted, unedited manuscript:

PURPOSE: We examined whether quality of mammography interpretation as performed by the original reading radiologist varied by patient sociodemographic characteristics.

METHODS: For 149 patients residing in Chicago and diagnosed in 2005-2008, we obtained the original index mammogram that detected the breast cancer and at least one prior mammogram that did not detect the cancer performed within 2 years of the index mammogram. A single breast imaging specialist performed a blinded review of the prior mammogram. Potentially missed detection was defined as an actionable lesion seen during a blinded review of the prior mammogram that was in the same quadrant as the cancer on the index mammogram.

RESULTS: Of 149 prior mammograms originally read as non-malignant, 46% (N=68) had a potentially detectable lesion. In unadjusted analyses, potentially missed detection was greater among minority patients (54% vs. 39%, p=0.07), for patients with incomes below $30,000 (65% vs. 36%, p<0.01), with less education (58% vs. 39%, p=0.02), and lacking private health insurance (63% vs. 40%, p=0.02). Likelihood ratio tests for the inclusion of socioeconomic variables in multivariable logistic regression models were highly significant (p<=0.02).

CONCLUSIONS: Disadvantaged socioeconomic status appears to be associated with potentially missed detection of breast cancer at mammography screening.

See full text via PubMed.