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Social Determinants of Health May Influence Undiagnosed Breast Cancer Risk


Research presented at this year’s annual meeting of the Radiological Society of North America shows the possible impact of food or housing insecurity on follow-up appointments for breast cancer.

Research presented at this year’s annual meeting of the Radiological Society of North America shows the possible impact of social determinants of health (SDOH) on follow-up appointments for breast cancer. The findings demonstrate a possible link between risk for undiagnosed breast cancer and length of lapse in follow-up appointment.

“Diagnosing breast cancer at an early stage is very important for survival,” said Aaron Afran, a third-year medical student at Boston University School of Medicine (BUSM), in a statement. “Concerning mammography findings lead to the need for additional imaging, such as diagnostic mammography and ultrasound, and there can be a lapse in time between imaging appointments.”

Two groups of women who had breast imaging done at Bostom Medical Center (BMC) between January 2015 and December 2018 had their medical records retrospectively reviewed:

  • Group 1 had 4959 women. They had a screening mammography and subsequently were recommended for diagnostic imaging. Their BI-RADS score was 0, the mean age was 59.1 years, and a majority (56.2%) were Black.
  • Group 2 had 3028 women. They had diagnostic breast imaging and subsequently were recommended for biopsy. Their BI-RADS score was 4 or 5, the mean age was 60.9 years, and most (57.5%) were Black, as well.

For diagnostic imaging to biopsy, the longest lapses were seen with food (P < .001) and housing insecurity (P < .001), whereas having at least 1 SDOH (P < .001) or transportation issues (P = .0016) was linked with shorter lapses. Between screening mammography and diagnostic imaging, housing and food again exerted the most influence at extending the lapse, at P = .08 and P = .1405, respectively.

All of the women completed the BMC’s THRIVE screening tool, which addresses issues with education, employment, food, affording medications, housing, transportation, utilities, and caregiving. Close to one-third of the patients in both groups (group 1, 30.7%; group 2, 26.9%) had this complete data in their records, which covered from October 2017 to December 2018.

Afran posited that food and housing insecurity are simply more important priorities than imaging appointments among the patients studied.

“To best serve our patient population at a safety-net hospital, we must think creatively about the social factors that are preventing our patients from receiving the best care,” concluded Michael D. Fishman, MD, section chief of breast imaging at Boston Medical Center and the study’s senior author. “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?”

Previous research mirrors their findings, reported Afran, in that the issue of later breast cancer stage at diagnosis has been shown to be influenced by poverty, lack of education, and social isolation.

Suggested areas of future study include analyzing the effects of these findings on survival and those of specific interventions.


Afran A, Donghoon S, LeBedis C, Fishman MDC. The impact of social determinants of health on breast imaging utilization. Presented at: RSNA 2020; November 29-December 5, 2020. https://press.rsna.org/pressrelease/2020_resources/2227/video_4.mp4

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