Marsh Mary W, Benefield Thad S, Lee Sheila, Pritchard Michael, Earnhardt Katie, Agans Robert, Henderson Louise M
Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Womens Health (Larchmt). 2021 Apr;30(4):579-586. doi: 10.1089/jwh.2020.8528. Epub 2020 Sep 22.
Despite the lack of evidence that supplemental screening in women with dense breasts reduces breast cancer mortality, 38 states have passed breast density legislation, with some including recommendations for supplemental screening. The objective of this study is to compare the availability versus use of supplemental breast cancer screening modalities and determine factors driving use of supplemental screening in rural versus urban settings. A 50-item mailed survey using the Tailored Design Method was sent to American College of Radiology mammography-accredited facilities in North Carolina in 2017. Respondents included 94 facilities (48 rural and 46 urban locations). Survey questions focused on breast cancer and supplemental screening services, breast density, risk factors/assessment, and facility demographics. The survey response rate was 60.3% (94/156). Among the 94 respondents, 64.0% ( = 60) reported availability of any type of supplemental screening (digital breast tomosynthesis [DBT], ultrasound, or magnetic resonance imaging [MRI]). In facilities where supplemental screening modalities were available, the most commonly utilized supplemental screening modality was DBT (96.4%), compared with ultrasound (35.7%) and MRI (46.7%). Facilities reported using supplemental screening based on patient breast density (48.3%), referring physician recommendation (63.3%), reading radiologist recommendation (63.3%), breast cancer risk factors (48.3%), and patient request (40.0%). Urban facilities were more likely than rural facilities to base supplemental screening on breast cancer risk factors (62.5% vs. 32.1%; -value = 0.019), referring physician (75.0% vs. 50.0%; -value = 0.045), and reading radiologist (78.1% vs. 46.4%; -value = 0.011). In our study, supplemental screening modalities were widely available, with facilities more likely to use DBT for supplemental screening compared to other modalities.
尽管缺乏证据表明对乳腺致密的女性进行补充筛查可降低乳腺癌死亡率，但38个州已通过了乳腺密度立法，其中一些州还包括补充筛查的建议。本研究的目的是比较补充乳腺癌筛查方式的可及性与使用情况，并确定在农村和城市环境中推动补充筛查使用的因素。2017年，采用定制设计方法，向北卡罗来纳州美国放射学会认可的乳腺摄影设施发送了一份包含50个项目的邮寄调查问卷。受访者包括94家机构（48个农村地点和46个城市地点）。调查问题集中在乳腺癌和补充筛查服务、乳腺密度、风险因素/评估以及机构人口统计学特征。调查回复率为60.3%（94/156）。在94名受访者中，64.0%（n = 60）报告提供任何类型的补充筛查（数字乳腺断层合成[DBT]、超声或磁共振成像[MRI]）。在提供补充筛查方式的机构中，最常用的补充筛查方式是DBT（96.4%），相比之下，超声为（35.7%），MRI为（46.7%）。机构报告称，基于患者乳腺密度（48.3%）、转诊医生建议（63.3%）、阅片放射科医生建议（63.3%）、乳腺癌风险因素（48.3%）和患者要求（40.0%）来使用补充筛查。城市机构比农村机构更有可能基于乳腺癌风险因素（62.5%对32.1%；P值 = 0.019）、转诊医生（75.0%对50.0%；P值 = 0.045）和阅片放射科医生（78.1%对46.4%；P值 = 0.011）进行补充筛查。在我们的研究中，补充筛查方式广泛可得，与其他方式相比，机构更有可能使用DBT进行补充筛查。
