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Yi SY, Narayan AK, Miles RC, Martin Rother MD, Robbins JB, Flores EJ, Ross AB. Authors' Reply. J Am Coll Radiol 2024:S1546-1440(24)00129-7. [PMID: 38295919 DOI: 10.1016/j.jacr.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Sue Y Yi
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/SueYYiii
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Assistant Editor, JACR; Vice Chair, ACR Patient and Family Centered Care Outreach Committee. https://twitter.com/AnandKNarayan
| | - Randy C Miles
- Chief of Breast Imaging, Department of Radiology, Denver Health, Denver, Colorado. https://twitter.com/RMilesMD
| | - Maria D Martin Rother
- Director of Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/DanielaMartinMD
| | - Jessica B Robbins
- Vice Chair of Faculty Development and Enrichment, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/JRobbinsMD
| | - Efren J Flores
- Massachusetts General Hospital, Boston, Massachusetts; Associate Chair, Equity, Inclusion and Community Health, Massachusetts General Brigham Enterprise Radiology, Boston, Massachusetts; Associate Editor, JACR. https://twitter.com/EJFloresMD
| | - Andrew B Ross
- Fellowship Director, Musculoskeletal Imaging and Intervention.
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Zaki-Metias KM, Sharma S, Kolof H, Yan TD, Laule C, Carroll EF, Narayan AK, Spalluto LB, Yong-Hing CJ. An Analysis of the Use of Gender-Inclusive Terminology Amongst Radiology Vendors: Moving Forward From "Women's Imaging". Can Assoc Radiol J 2024:8465371231226164. [PMID: 38216858 DOI: 10.1177/08465371231226164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Affiliation(s)
- Kaitlin M Zaki-Metias
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Sonali Sharma
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hanna Kolof
- Department of Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Tyler D Yan
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cornelia Laule
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Physics & Astronomy, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | | | - Anand K Narayan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Ingram Cancer Center, Nashville, TN, USA
- Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
| | - Charlotte J Yong-Hing
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Diagnostic Imaging, BC Cancer, Vancouver, BC, Canada
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Yi SY, Narayan AK, Miles RC, Martin Rother MD, Robbins JB, Flores EJ, Ross AB. Patient, Provider, and Practice Characteristics Predicting Use of Diagnostic Imaging in Primary Care: Cross-Sectional Data From the National Ambulatory Medical Care Survey. J Am Coll Radiol 2023; 20:1193-1206. [PMID: 37422162 DOI: 10.1016/j.jacr.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To determine imaging utilization rates in outpatient primary care visits and factors influencing likelihood of imaging use. METHODS We used 2013 to 2018 National Ambulatory Medical Care Survey cross-sectional data. All visits to primary care clinics during the study period were included in the sample. Descriptive statistics on visit characteristics including imaging utilization were calculated. Logistic regression analyses evaluated the influence of a variety of patient-, provider-, and practice-level variables on the odds of obtaining diagnostic imaging, further subdivided by modality (radiographs, CT, MRI, and ultrasound). The data's survey weighting was accounted for to produce valid national-level estimates of imaging use for US office-based primary care visits. RESULTS Using survey weights, approximately 2.8 billion patient visits were included. Diagnostic imaging was ordered at 12.5% of visits with radiographs the most common (4.3%) and MRI the least common (0.8%). Imaging utilization was similar or greater among minority patients compared with White, non-Hispanic patients. Physician assistants used imaging at higher rates than physicians, in particular CT at 6.5% of visits compared with 0.7% for doctors of medicine and doctors of osteopathic medicine (odds ratio 5.67, 95% confidence interval 4.07-7.88). CONCLUSION Disparities in rates of imaging utilization for minorities seen in other health care settings were not present in this sample of primary care visits, supporting that access to primary care is a path to promote health equity. Higher rates of imaging utilization among advanced-level practitioners highlight an opportunity to evaluate imaging appropriateness and promote equitable, high-value imaging among all practitioners.
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Affiliation(s)
- Sue Y Yi
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/SueYYiii
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Assistant Editor of JACR and Vice Chair, ACR Patient and Family Centered Care Outreach Committee. https://twitter.com/AnandKNarayan
| | - Randy C Miles
- Chief of Breast Imaging, Department of Radiology, Denver Health, Denver, Colorado. https://twitter.com/RMilesMD
| | - Maria D Martin Rother
- Director of Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/DanielaMartinMD
| | - Jessica B Robbins
- Vice Chair of Faculty Development and Enrichment, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/JRobbinsMD
| | - Efren J Flores
- Massachusetts General Hospital, Boston, Massachusetts, and Associate Chair, Equity, Inclusion and Community Health, Massachusetts General Brigham Enterprise Radiology, Boston, Massachusetts; Associate Editor of JACR. https://twitter.com/EJFloresMD
| | - Andrew B Ross
- Fellowship Director-Musculoskeletal Imaging and Intervention, Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, CSC, Madison, Wisconsin 53792.
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Narayan AK, Miles RC, Milton A, Salazar G, Spalluto LB, Babagbemi K, Stowell JT, Flores EJ, Dako F, Weissman IA. Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:711-719. [PMID: 37255040 DOI: 10.2214/ajr.23.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patient-centered care (PCC) and equity are two of the six core domains of quality health care, according to the Institute of Medicine. Exceptional imaging care requires radiology practices to provide patient-centered (i.e., respectful and responsive to individual patient preferences, needs, and values) and equitable (i.e., does not vary in quality on the basis of gender, ethnicity, geographic location, or socioeconomic status) care. Specific barriers that prevent the delivery of patient-centered equitable care include information gaps, breaches of trust, organizational medical culture, and financial incentives. Information gaps limit practitioners in understanding the lived experience of patients. Breaches of trust prevent patients from seeking needed medical care. Organizational medical cultures may not be centered around patient experiences. Financial incentives can impede practitioners' ability to spend the time and resources required to meet patient goals and needs. Intentional approaches that integrate core principles in both PCC and health equity are required to deliver high-quality patient-centered imaging care for diverse patient populations. The purpose of this AJR Expert Panel Narrative Review is to review the origins of the PCC movement in radiology, characterize connections between the PCC and health equity movements, and describe concrete examples of ways to foster patient-centered equitable care in radiology.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | | | - Arissa Milton
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | - Gloria Salazar
- Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Lucy B Spalluto
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Department of Radiology, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, TN
| | - Kemi Babagbemi
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Farouk Dako
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ian A Weissman
- Department of Radiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Poterala JE, Stanley E, Narayan AK, Guevara AE, Naeger DM, Miles RC. Mammography Screening Outreach Through Non-Primary Care-Based Services. J Am Coll Radiol 2023; 20:1014-1021. [PMID: 37423346 DOI: 10.1016/j.jacr.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To estimate the proportion of patients visiting urgent care centers or emergency departments or being hospitalized who were not up to date with recommended mammography screening to assess the potential impact of non-primary care-based cancer screening interventions. METHODS Adult participants from the 2019 National Health Interview Survey were included. Among participants not up to date with breast cancer screening guidelines based on ACR recommendations, the proportion of patients reporting an urgent care, emergency department visit, or hospitalization within the last year was estimated accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and mammography screening adherence. RESULTS The study included 9,139 women between the ages of 40 and 74 years without history of breast cancer. Of these respondents, 44.9% did not report mammography screening within the last year. Among participants who did not report mammography screening, 29.2% reported visiting an urgent care center, 21.8% reported visiting an emergency room, and 9.6% reported being hospitalized within the last year. The majority of patients receiving non-primary care-based services, who were not up to date with mammography screening, were from historically underserved groups including Black and Hispanic patients. CONCLUSION Nearly 10% to 30% of participants who have not obtained recommended breast cancer screening have visited non-primary care-based services including urgent care centers or emergency rooms or have been hospitalized within the last year.
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Affiliation(s)
- Johanna E Poterala
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Edward Stanley
- School of Medicine, American University of the Caribbean, Pembroke Pines, Florida
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - David M Naeger
- Director of Radiology; Vice Chair, Department of Radiology, Denver Health Medical Center, University of Colorado, Denver, Colorado
| | - Randy C Miles
- Chief of Breast Imaging; Associate Director of Radiology for Research, Denver Health Medical Center, Denver, Colorado.
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Slanetz PJ, Almeky S, Narayan AK, Bello JA. Pursuing Imaging Equity-Overcoming Barriers, Finding Opportunities. J Am Coll Radiol 2023; 20:1075-1077. [PMID: 37619799 DOI: 10.1016/j.jacr.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Priscilla J Slanetz
- Vice Chair of Academic Affairs, Department of Radiology, and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center, Boston, Massachusetts, and is also from the Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Director of Early Career Faculty Development and Academic Writing Programs for Boston University Medical Group; Past President of Massachusetts Radiological Society; President of the Association of University Radiologists; and Subspecialty Chair of the ACR Appropriateness Criteria Breast Imaging Panels.
| | - Somiah Almeky
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Vice President of the Massachusetts Radiological Society; Resident, Fellow Section; President-Elect for the next academic year; Radiology Advocacy Network Leader; member Medical Student and Resident teaching committee; and Diversity Equity and Inclusion Council Fellow at Boston Medical Center
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Associate Director of the University of Wisconsin Carbone Cancer Center for Diversity, Equity, and Inclusion; Vice Chair of the ACR's Patient- and Family-Centered Care Outreach Committee; and Director at Large of the Wisconsin Radiological Society
| | - Jacqueline A Bello
- Director of Neuroradiology, Department of Radiology, Montefiore Medical Center, Bronx, New York; Zimmer-Hardy Professor of Neuroradiology, Department of Radiology, Albert Einstein College of Medicine; Chair, ACR Board of Chancellors; and a Past President of the New York Radiological Society, the New York Roentgen Society, and the American Society of Neuroradiology
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Peterson MS, Gegios AR, Elezaby MA, Salkowski LR, Woods RW, Narayan AK, Strigel RM, Roy M, Fowler AM. Breast Imaging and Intervention during Pregnancy and Lactation. Radiographics 2023; 43:e230014. [PMID: 37708073 PMCID: PMC10560982 DOI: 10.1148/rg.230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 09/16/2023]
Abstract
Physiologic changes that occur in the breast during pregnancy and lactation create challenges for breast cancer screening and diagnosis. Despite these challenges, imaging evaluation should not be deferred, because delayed diagnosis of pregnancy-associated breast cancer contributes to poor outcomes. Both screening and diagnostic imaging can be safely performed using protocols based on age, breast cancer risk, and whether the patient is pregnant or lactating. US is the preferred initial imaging modality for the evaluation of clinical symptoms in pregnant women, followed by mammography if the US findings are suspicious for malignancy or do not show the cause of the clinical symptom. Breast MRI is not recommended during pregnancy because of the use of intravenous gadolinium-based contrast agents. Diagnostic imaging for lactating women is the same as that for nonpregnant nonlactating individuals, beginning with US for patients younger than 30 years old and mammography followed by US for patients aged 30 years and older. MRI can be performed for high-risk screening and local-regional staging in lactating women. The radiologist may encounter a wide variety of breast abnormalities, some specific to pregnancy and lactation, including normal physiologic changes, benign disorders, and malignant neoplasms. Although most masses encountered are benign, biopsy should be performed if the imaging characteristics are suspicious for cancer or if the finding does not resolve after a short period of clinical follow-up. Knowledge of the expected imaging appearance of physiologic changes and common benign conditions of pregnancy and lactation is critical for differentiating these findings from pregnancy-associated breast cancer. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Molly S. Peterson
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Alison R. Gegios
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Mai A. Elezaby
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Lonie R. Salkowski
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Ryan W. Woods
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Anand K. Narayan
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Roberta M. Strigel
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Madhuchhanda Roy
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
| | - Amy M. Fowler
- From the Department of Radiology (M.S.P., A.R.G., M.A.E., L.R.S.,
R.W.W., A.K.N., R.M.S., A.M.F.), Department of Medical Physics (L.R.S., R.M.S.,
A.M.F.), and Department of Pathology and Laboratory Medicine (M.R.), University
of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI
53792-3252; and University of Wisconsin Carbone Cancer Center, Madison, Wis
(A.K.N., R.M.S., A.M.F.)
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Chowdhry DN, Miles RC, Escamilla Guevara A, Flores EJ, Narayan AK. Prevalence of Modifiable Breast Cancer Risk Factors and Potential Opportunities for Primary Prevention Among Women Engaged in Screening Mammography: National Health Interview Survey Results. J Breast Imaging 2023; 5:538-545. [PMID: 38416916 DOI: 10.1093/jbi/wbad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine the prevalence of modifiable breast cancer risk factors among women engaged in screening mammography using nationally representative cross-sectional survey data and to inform potential opportunities for breast facilities to contribute to primary prevention. METHODS 2018 National Health Interview Survey respondents who were women ages 40-74 years without history of breast cancer were included and then categorized based on whether they reported screening mammography within the prior two years. Proportions of these women reporting evidence-based modifiable breast cancer risk factors, including elevated body mass index (BMI), lack of physical activity, or moderate or heavy alcohol consumption were calculated and stratified by demographics. Multivariable logistic regression was used to estimate the association between these risk factors and sociodemographic characteristics. RESULTS Among 4989 women meeting inclusion criteria and reporting screening mammography, 79% reported at least one modifiable risk factor. Elevated BMI was the most reported risk factor (67%), followed by lack of physical activity (24%) and alcohol consumption (16%). The majority of each race/ethnicity category reported at least one modifiable risk factor, with the highest proportion reported by Black respondents (90%). Asian, college educated, and higher-income participants were less likely to have at least one modifiable risk factor. CONCLUSION Modifiable breast cancer risk factors are prevalent among women engaged in screening mammography. This provides potential opportunities for breast imaging facilities to contribute to the primary prevention of breast cancer by providing resources for lifestyle modification at the time of screening mammography.
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Affiliation(s)
- Divya N Chowdhry
- University of Rochester Medical Center, Division of Breast Imaging, Rochester, NY, USA
| | - Randy C Miles
- Denver Health Medical Center, Department of Radiology, Denver, CO, USA
| | | | - Efren J Flores
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Anand K Narayan
- University of Wisconsin-Madison, Department of Radiology, Madison, WI, USA
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Narayan AK, DeBenedectis CM. Reply to "How We Define Diversity". AJR Am J Roentgenol 2023; 221:396. [PMID: 37406200 DOI: 10.2214/ajr.23.29377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
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Mango VL, Stoeckl EM, Reid NJ, Miles RC, Flores EJ, Weissman IA, Wagner A, Morla A, Jose O, Narayan AK. Impact of High Neighborhood Socioeconomic Deprivation on Access to Accredited Breast Imaging Screening and Diagnostic Facilities. J Am Coll Radiol 2023; 20:634-639. [PMID: 37230233 PMCID: PMC10528477 DOI: 10.1016/j.jacr.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE The aim of this study was to evaluate the presence or absence of accredited breast imaging facilities in ZIP codes with high or low neighborhood socioeconomic deprivation. METHODS A retrospective ecological study design was used. Neighborhood socioeconomic disadvantage rankings at the ZIP code level were defined by the University of Wisconsin Neighborhood Atlas Area Deprivation Index. Outcomes included the presence or absence of FDA- or ACR-accredited mammographic facilities, accredited stereotactic biopsy or breast ultrasound facilities, and ACR Breast Imaging Centers of Excellence. US Department of Agriculture rural-urban commuting area codes were used to define urban and rural status. Access to breast imaging facilities in high-disadvantage (≥97th percentile) and low-disadvantage (≤3rd percentile) ZIP codes was compared using χ2 tests, stratified by urban or rural status. RESULTS Among 41,683 ZIP codes, 2,796 were classified as high disadvantage (1,160 rural, 1,636 urban) and 1,028 as low disadvantage (39 rural, 989 urban). High-disadvantage ZIP codes were more likely rural (P < .001) and less likely to have FDA-certified mammographic facilities (28% versus 35%, P < .001), ACR-accredited stereotactic biopsy (7% versus 15%, P < .001), breast ultrasound (9% versus 23%, P < .001), or Breast Imaging Centers of Excellence (7% versus 16%, P < .001). Among urban areas, high-disadvantage ZIP codes were less likely to have FDA-certified mammographic facilities (30% versus 36%, P = .002), ACR-accredited stereotactic biopsy (10% versus 16%, P < .001), breast ultrasound (13% versus 23%, P < .001), and Breast Imaging Centers of Excellence (10% versus 16%, P < .001). CONCLUSIONS People living in ZIP codes with high socioeconomic disadvantage are less likely to have accredited breast imaging facilities within their ZIP codes, which may contribute to disparities in access to breast cancer care experienced by underserved groups living in these areas.
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Affiliation(s)
- Victoria L Mango
- Director of Radiology, Memorial Sloan Kettering Cancer Center Ralph Lauren Center, and Assistant Director, Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Nicholas J Reid
- Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Randy C Miles
- Chief of Breast Imaging and Associate Director of Radiology for Research, Denver Health, Denver, Colorado
| | - Efren J Flores
- Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ian A Weissman
- Milwaukee VA Medical Center, Milwaukee, Wisconsin; Chair, ACR Commission on Patient- and Family-Centered Care Outreach Committee, Chair, ACR Commission on General, Small, Emergency and/or Rural Practice, Veterans Affairs Committee, and President, Wisconsin Radiological Society
| | | | - Alexander Morla
- Department of Biology, University of Puerto Rico, Río Piedras Campus, San Juan, Puerto Rico
| | | | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Vice Chair, ACR Commission on Patient- and Family-Centered Care Outreach Committee
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Pena MA, Sudarshan A, Muns CM, Narayan AK, González C, Neil J, Rhoades DA, Doescher MP, Flores EJ. Analysis of Geographic Accessibility of Breast, Lung, and Colorectal Cancer Screening Centers among American Indian and Alaskan Native Tribes. J Am Coll Radiol 2023:S1546-1440(23)00344-7. [PMID: 37230232 DOI: 10.1016/j.jacr.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE To evaluate geographic accessibility of ACR mammographic screening (MS), lung cancer screening (LCS), and CT colorectal cancer screening (CTCS) centers among US federally recognized American Indian and Alaskan Native (AI/AN) tribes. METHODS Distances from AI/AN tribes' ZIP codes to their closest ACR-accredited LCS and CTCS centers were recorded using tools from the ACR website. The FDA's database was used for MS. Persistent adult poverty (PPC-A), persistent child poverty (PPC-C), and rurality indexes (rural-urban continuum codes) were from the US Department of Agriculture. Logistic and linear regression analyses were used to assess distances to screening centers and relationships among rurality, PPC-A, and PPC-C. RESULTS Five hundred ninety-four federally recognized AI/AN tribes met the inclusion criteria. Among all closest MS, LCS, or CTCS center to AI/AN tribes, 77.8% (1,387 of 1,782) were located within 200 miles, with a mean distance of 53.6 ± 53.0 miles. Most tribes (93.6% [557 of 594]) had MS centers within 200 miles, 76.4% (454 of 594) had LCS centers within 200 miles, and 63.5% (376 of 594) had CTCS centers within 200 miles. Counties with PPC-A (odds ratio [OR], 0.47; P < .001) and PPC-C (OR, 0.19; P < .001) were significantly associated with decreased odds of having a cancer screening center within 200 miles. PPC-C was associated with decreased likelihood of having an LCS center (OR, 0.24; P < .001) and an CTCS center (OR, 0.52; P < .001) within the same state as the tribe's location. No significant association was found between PPC-A and PPC-C and MS centers. CONCLUSIONS AI/AN tribes experience distance barriers to ACR-accredited screening centers, resulting in cancer screening deserts. Programs are needed to increase equity in screening access among AI/AN tribes.
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Affiliation(s)
- Miguel A Pena
- Department of Radiology, Massachusetts General Hospital, Boston, MA; Harvard Kennedy School of Government, Cambridge, MA
| | - Anirudh Sudarshan
- Department of Radiology, Massachusetts General Hospital, Boston, MA; The University of Texas at Austin, Austin, TX
| | - Claudia M Muns
- University of Puerto Rico, School of Medicine, San Juan, PR
| | - Anand K Narayan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - Carlos González
- Universidad Central del Caribe, School of Medicine, Bayamon, PR
| | - Jordan Neil
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Dorothy A Rhoades
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Mark P Doescher
- Department of Family and Preventive Medicine, University of Oklahoma College of Medicine
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA.
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12
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Milton AJ, Flores EJ, Charles EF, Elezaby MA, Ward EC, Lee CI, Woods RW, Martin Rother MD, Strigel RM, Narayan AK. Community-based Participatory Research: A Practical Guide for Radiologists. Radiographics 2023; 43:e220145. [PMID: 37104126 PMCID: PMC10190132 DOI: 10.1148/rg.220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 04/28/2023]
Abstract
Community-based participatory research (CBPR) is defined by the Kellogg Community Health Scholars Program as a collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each community member brings. The CBPR process begins with a research topic of importance to the community, with the goal of combining knowledge and action with social change to improve community health and eliminate health disparities. CBPR engages and empowers affected communities to collaborate in defining the research question; sharing the study design process; collecting, analyzing, and disseminating the data; and implementing solutions. A CBPR approach in radiology has several potential applications, including removing limitations to high-quality imaging, improving secondary prevention, identifying barriers to technology access, and increasing diversity in the research participation for clinical trials. The authors provide an overview with the definitions of CBPR, explain how to conduct CBPR, and illustrate its applications in radiology. Finally, the challenges of CBPR and useful resources are discussed in detail. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Arissa J. Milton
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Efrén J. Flores
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Eden F. Charles
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Mai A. Elezaby
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Earlise C. Ward
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Christoph I. Lee
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Ryan W. Woods
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Maria D. Martin Rother
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Roberta M. Strigel
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
| | - Anand K. Narayan
- From the Department of Radiology (M.A.E., R.W.W., M.D.M.R., R.M.S.,
A.K.N.), School of Medicine and Public Health (A.J.M, E.F.C.), University of
Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792-3252; Department
of Radiology, Massachusetts General Hospital, Boston, Mass (E.J.F.); Department
of Family Medicine and Nursing, School of Nursing, University of
Wisconsin–Madison, Madison, Wis (E.C.W.); Department of Radiology, School
of Medicine, University of Washington, Seattle, Wash (C.I.L.); and Carbone
Cancer Center, University of Wisconsin–Madison, Madison, Wis (E.C.W,
R.M.S, A.K.N.)
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13
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Jose O, Stoeckl EM, Miles RC, Mango VL, Reid NJ, Wagner ASB, Weissman IA, Flores EJ, Morla A, Narayan AK. The Impact of Extreme Neighborhood Socioeconomic Deprivation on Access to American College of Radiology-accredited Advanced Imaging Facilities. Radiology 2023; 307:e222182. [PMID: 36916894 PMCID: PMC10140634 DOI: 10.1148/radiol.222182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/08/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Oyinloye Jose
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Elizabeth M. Stoeckl
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Randy C. Miles
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Victoria L. Mango
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Nicholas J. Reid
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Amelia S. B. Wagner
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Ian A. Weissman
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Efren J. Flores
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Alexander Morla
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
| | - Anand K. Narayan
- From the Meharry Medical College, Nashville, Tenn (O.J.); Department
of Radiology, University of Wisconsin School of Medicine and Public Health, 600
Highland Ave, F6/178C, Madison, WI 53792-3252 (E.M.S., A.S.B.W., A.M., A.K.N.);
Department of Radiology, Denver Health, Denver, Colo (R.C.M.); Department of
Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.L.M.);
Department of Radiology, Massachusetts General Hospital, Boston, Mass (N.J.R.,
E.J.F.); and Department of Radiology, Clement J. Zablocki Veterans Affairs
Medical Center, Milwaukee, Wis (I.A.W.)
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14
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Bucknor MD, Narayan AK, Spalluto LB. A Framework for Developing Health Equity Initiatives in Radiology. J Am Coll Radiol 2023; 20:385-392. [PMID: 36922114 DOI: 10.1016/j.jacr.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 03/16/2023]
Abstract
PURPOSE In recent years, radiology departments have increasingly recognized the extent of health care disparities related to imaging and image-guided interventions. The goal of this article is to provide a framework for developing a health equity initiative in radiology and to articulate key defining factors. METHODS This article leverages the experience of three academic radiology departments and explores key principles that emerged when observing the experiences of these departments that have begun to engage in health equity-focused work. RESULTS A four-component framework is described for a health equity initiative in radiology consisting of (1) environmental scan and blueprint, (2) design and implementation, (3) initiative evaluation, and (4) community engagement. Key facilitators include a comprehensive environmental scan, early stakeholder engagement and consensus building, implementation science design thinking, and multitiered community engagement. CONCLUSIONS All radiology organizations should strive to develop, pilot, and evaluate novel initiatives that promote equitable access to high-quality imaging services. Establishing systems for high-quality data collection is critical to success. An implementation science approach provides a robust framework for developing and testing novel health equity initiatives in radiology. Community engagement is critical at all stages of the health equity initiative time line.
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Affiliation(s)
- Matthew D Bucknor
- Associate Chair for Wellbeing and Professional Climate, Department of Radiology and Biomedical Imaging and Executive Sponsor, Differences Matter, University of California, San Francisco, California.
| | - Anand K Narayan
- Vice Chair of Health Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/%20AnandKNarayan
| | - Lucy B Spalluto
- Chair of Health Equity, Department of Radiology, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, Tennessee. https://twitter.com/%20LBSrad
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Sohn YJ, Flores EJ, Narayan AK, Wang GX, Miles RC. Influence of Perceived Racial Stigma on Breast Cancer Screening Engagement. J Am Coll Radiol 2023; 20:151-155. [PMID: 36280212 DOI: 10.1016/j.jacr.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gary X Wang
- Co-Chair, Diversity, Equity, and Inclusion Patient Experience Subcommittee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Randy C Miles
- Chief of Breast Imaging and Associate Director of Research in Radiology, Denver Health, Denver, Colorado.
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16
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Abraham P, Balthazar P, Reid NJ, Flores EJ, Narayan AK. The Digital Divide in Radiology: Computer Use for Health Care-related Tasks and Breast Cancer Screening. Radiology 2023; 306:218-219. [PMID: 36040332 DOI: 10.1148/radiol.220796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter Abraham
- From the Department of Radiology, University of California, San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA 92037 (P.A.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (N.J.R., E.J.F.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.N.)
| | - Patricia Balthazar
- From the Department of Radiology, University of California, San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA 92037 (P.A.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (N.J.R., E.J.F.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.N.)
| | - Nicholas James Reid
- From the Department of Radiology, University of California, San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA 92037 (P.A.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (N.J.R., E.J.F.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.N.)
| | - Efrén J Flores
- From the Department of Radiology, University of California, San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA 92037 (P.A.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (N.J.R., E.J.F.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.N.)
| | - Anand K Narayan
- From the Department of Radiology, University of California, San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA 92037 (P.A.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (N.J.R., E.J.F.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.K.N.)
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17
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Vengalasetti YV, Narayan AK, Brown CA, Boakye-Ansa N, Strigel RM, Elezaby MA, Martin MD, Woods RW, Flores EJ, Miles RC. Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey. Acad Radiol 2022; 30:1101-1106. [PMID: 35965156 DOI: 10.1016/j.acra.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group. METHODS Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements. RESULTS 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001). CONCLUSION Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.
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Affiliation(s)
- Y V Vengalasetti
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - A K Narayan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - C A Brown
- School of Medicine, Meharry Medical College, Nashville, TN
| | - N Boakye-Ansa
- School of Medicine, Meharry Medical College, Nashville, TN
| | - R M Strigel
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - M A Elezaby
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - M D Martin
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - R W Woods
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - E J Flores
- Department of Radiology, Harvard Medical School, Harvard University, Boston, MA
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Miles RC, Lehman CD, Chou SHS, Sohn YJ, Guerrier CE, Wang GX, Narayan AK. Patient Sociodemographic Characteristics Associated With Saturday Breast Imaging Clinic Utilization. J Breast Imaging 2022; 4:378-383. [PMID: 38416978 DOI: 10.1093/jbi/wbac035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To determine patient sociodemographic characteristics associated with breast imaging utilization on Saturdays to inform potential initiatives designed to improve access and reduce disparities in breast cancer care. METHODS This was an IRB-approved retrospective cross-sectional study. All adult women (aged ≥18 years) who received a screening or diagnostic examination at our breast imaging facility from January 1, 2016 to December 31, 2017 were included. Patient characteristics including age, race, primary language, partnership status, insurance status, and primary care physician status were collected using the electronic medical record. Multiple variable logistic regression analyses were performed to evaluate patient characteristics associated with utilization. RESULTS Of 53 695 patients who underwent a screening examination and 10 363 patients who underwent a diagnostic examination over our study period, 9.6% (5135/53 695) and 2.0% (209/10 363) of patients obtained their respective examination on a Saturday. In our multiple variable logistic regression analyses, racial/ethnic minorities (odds ratio [OR], 1.5; 95% confidence interval [CI]: 1.4-1.6; P < 0.01) and women who speak English as a second language (OR, 1.1; 95% CI: 1.0-1.3; P = 0.03) were more likely to obtain their screening mammogram on Saturday than their respective counterparts. CONCLUSION Racial/ethnic minorities and women who speak English as a second language were more likely to obtain their screening mammogram on Saturdays than their respective counterparts. Initiatives to extend availability of breast imaging exams outside of standard business hours increases access for historically underserved groups, which can be used as a tool to reduce breast cancer-related disparities in care.
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Affiliation(s)
- Randy C Miles
- Denver Health, Department of Radiology, Denver, CO, USA
| | - Constance D Lehman
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Shinn-Huey S Chou
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Young-Jin Sohn
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Claude E Guerrier
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Gary X Wang
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Anand K Narayan
- University of Wisconsin-Madison, Department of Radiology, Madison, WI, USA
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Miles RC, Flores EJ, Carlos RC, Boakye-Ansa NK, Brown C, Sohn YJ, Narayan AK. Impact of Health Care-Associated Cost Concerns on Mammography Utilization: Cross-Sectional Survey Results From the National Health Interview Survey. J Am Coll Radiol 2022; 19:1081-1087. [PMID: 35879187 DOI: 10.1016/j.jacr.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Health care-related cost concerns and financial toxicity are increasingly recognized barriers along the breast cancer care continuum. The purpose of this study was to evaluate the association between patient-reported cost concerns and screening mammography utilization. METHODS Survey participants aged 40 to 74 years from the 2018 National Health Interview Survey without personal history of breast cancer were included (response rate: 64%). Respondents were queried if they had experienced specific access-related health care barriers. Multiple variable logistic regression analyses were performed to evaluate the association between barriers to care and patient-reported screening mammography utilization. RESULTS Of survey respondents, 7,511 women were included. Of this group, 68.9% reported receiving a screening mammogram within the last 2 years and 52.2% reported receiving a screening mammogram within the last year. Of all survey respondents, 48.4% reported worry paying medical bills. Patients who reported worry about paying medical bills (odds ratio [OR] 0.86; 95% confidence interval [CI]: 0.76-0.97; P = .01), challenges affording dental care (OR 0.65; 95% CI: 0.54-0.77; P < .01), and challenges affording eyeglasses (OR 0.67; 95% CI: 0.54-0.84; P < .01) were less likely to report screening mammography use than their respective counterparts. Patients who skipped medication doses (OR 0.69; 95% CI: 0.52-0.91; P < .01), took less medication, (OR 0.63; 95% CI: 0.48-0.82; P < .01), and delayed filling prescriptions (OR 0.71; 95% CI: 0.56-0.90; P < .01) to save money were also less likely to report receiving mammography screening. CONCLUSION Patient-reported cost-related barriers are associated with decreased utilization of routine mammography.
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Affiliation(s)
- Randy C Miles
- Chief, Breast Imaging and Associate Director, Research in Radiology, Denver Health, University of Colorado, Denver, Colorado.
| | - Efren J Flores
- Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ruth C Carlos
- Assistant Chair, Clinical Research, Department of Radiology, University of Michigan, Ann Arbor, Michigan; and Editor-in-Chief, JACR
| | | | - Corey Brown
- Meharry Medical College, Nashville, Tennessee
| | - Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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O'Connor B, Boakye-Ansa NK, Brown CA, Flores EJ, Ross AB, Martin MD, Robbins JB, Narayan AK. Predictors of CT Colonography Use: Results From the 2019 National Health Interview Cross-Sectional Survey. J Am Coll Radiol 2022; 19:874-880. [PMID: 35490713 DOI: 10.1016/j.jacr.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE CT colonography (CTC) is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). Prior studies suggest that CTC utilization remains low. However, there are few studies evaluating recent CTC utilization and predictors of CTC utilization. Our purpose was to estimate recent nationwide CTC utilization and evaluate predictors of CTC utilization using 2019 nationally representative cross-sectional survey data. METHODS Participants between ages 50 and 75 without colorectal cancer history in the 2019 National Health Interview Survey cross-sectional data were included. Proportion of participants reporting utilization of CTC was estimated, accounting for complex survey design elements. Multiple variable logistic regression analyses evaluated predictors of CTC utilization. Analyses were conducted accounting for complex survey design elements to obtain valid estimates for the civilian, noninstitutionalized US population. RESULTS In all, 13,709 respondents were included, and 1.4% reported undergoing CTC, of whom 39.9% underwent CTC within the last year, 18.5% within the last 2 years, 13.0% within the last 3 years, 7.8% within the last 5 years, 11.2% within the last 10 years, and 9.6% underwent CTC 10 years ago or more. Multiple variable logistic regression analyses revealed that Hispanic (odds ratio 2.67, 95% confidence interval 1.66-4.29, P < .001) and Black (odds ratio 2.47, 95% confidence interval 1.60-3.82, P < .001) participants were more likely than White participants to undergo CTC. CONCLUSION Survey results suggest that nationwide utilization of CTC remains low. Black and Hispanic participants were more likely than White participants to report undergoing CTC. Promotion of CTC may reduce racial and ethnic disparities in colorectal cancer screening.
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Affiliation(s)
- Brandon O'Connor
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas.
| | | | | | - Efren J Flores
- Massachusetts General Hospital, Boston, Massachusetts; and Associate Chair, Equity, Inclusion and Community Health, Massachusetts General Brigham Enterprise Radiology, Boston, Massachusetts
| | - Andrew B Ross
- Musculoskeletal Fellowship Program Director, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maria D Martin
- Director, Diversity and Inclusion, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jessica B Robbins
- Assistant Residency Program Director and Vice Chair of Faculty Development and Enrichment, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; and Vice Chair of the ACR PFCC Outreach Committee
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Little BP, Gagne SM, Fintelmann FJ, McDermott S, Mendoza DP, Petranovic M, Price MC, Stowell JT, Narayan AK, Flores EJ. United States lung cancer screening program websites: radiology representation, multimedia and multilingual content. Clin Imaging 2022; 86:83-88. [DOI: 10.1016/j.clinimag.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/03/2022]
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22
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Colwell RL, Narayan AK, Ross AB. Patient Race or Ethnicity and the Use of Diagnostic Imaging: A Systematic Review. J Am Coll Radiol 2022; 19:521-528. [PMID: 35216945 DOI: 10.1016/j.jacr.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To summarize the existing literature evaluating differences in imaging use based on patient race and ethnicity. METHODS The authors performed a structured search of four databases for the dates January 1, 2000, to April 13, 2021, using key words and derivatives focused on imaging and patient race. Retrieved citations were reviewed by abstract and then full text to identify articles that evaluated the likelihood of imaging use by patient race or ethnicity controlling for sociodemographic factors. Data regarding publication characteristics, study population, clinical setting, and results was extracted and summarized. RESULTS The structured search identified 2,938 articles of which 206 met inclusion criteria. Most studies (87%, 179 of 206) were conducted in the United States, and the majority (72%, 149 of 206) found decreased or inappropriate imaging use in minority groups. Breast cancer screening was the most common clinical setting (50%, 104 of 206), followed by cancer care (10%, 21 of 206) and general imaging use (9%, 19 of 206). Government-administered surveys were the most common data source (40%, 82 of 206). Only a small minority of studies (8%, 17 of 206) evaluated strategies to mitigate the unequal use of imaging based on patient race and ethnicity. DISCUSSION The existing literature shows decreased or inappropriate use of diagnostic imaging for minority patients across a wide variety of clinical settings. Although the number of articles on the topic is large, the majority are clustered around specific topics, and few articles evaluate potential strategies to reduce the inequitable use of diagnostic imaging.
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Affiliation(s)
- Rebecca L Colwell
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anand K Narayan
- JACR editorial board member; Vice Chair of Equity, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew B Ross
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Harrington SG, Wood M, Porter KK, Gupta Y, Esfahani SA, Daye D, Kilcoyne A, Donelan K, Narayan AK. Promoting Lactation Support: Challenges and Solutions to Supporting Breastfeeding Radiologists. Acad Radiol 2022; 29:175-180. [PMID: 33293255 DOI: 10.1016/j.acra.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals. MATERIALS AND METHODS A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption. RESULTS 50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05). CONCLUSION Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.
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Gupta Y, Nguyen JK, Shah N, Heitkamp DE, Narayan AK. A National Virtual Mentorship Program in Radiology: Fostering Inclusivity to Improve Health Equity. J Am Coll Radiol 2022; 19:204-206. [PMID: 35033312 DOI: 10.1016/j.jacr.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Yasha Gupta
- Department of Radiology, Mount Auburn Hospital, Cambridge, Massachusetts.
| | - Jeffers K Nguyen
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Neal Shah
- Department of Radiology, Edward Via College of Osteopathic Medicine, Blacksburg, Virginia
| | - Darel E Heitkamp
- Department of Radiology, AdventHealth Medical Group, Orlando, Florida
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Pourvaziri A, Narayan AK, Tso D, Baliyan V, Glover M, Bizzo BC, Kako B, Succi MD, Lev MH, Flores EJ. Imaging Information Overload: Quantifying the burden of interpretive and non-interpretive tasks for CT angiography for aortic pathologies in emergency radiology. Curr Probl Diagn Radiol 2022; 51:546-551. [DOI: 10.1067/j.cpradiol.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 01/05/2022] [Indexed: 12/20/2022]
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Ross AB, Rother MDM, Miles RC, Flores EJ, Boakye-Ansa NK, Brown C, Narayan AK. Racial and/or Ethnic Disparities in the Use of Imaging: Results from the 2015 National Health Interview Survey. Radiology 2021; 302:140-142. [PMID: 34726530 DOI: 10.1148/radiol.2021211449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew B Ross
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
| | - Maria Daniela Martin Rother
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
| | - Randy C Miles
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
| | - Efrén J Flores
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
| | - Newman Kwame Boakye-Ansa
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
| | - Corey Brown
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
| | - Anand K Narayan
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (A.B.R., M.D.M.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.C.M.); Department of Radiology, Harvard Medical School, Harvard University, 55 Fruit St, Boston, MA 02114 (E.J.F., A.K.N.); and Meharry Medical College School of Medicine, Nashville, Tenn (N.K.B.A., C.B.)
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Narayan AK, Chowdhry DN, Fintelmann FJ, Little BP, Shepard JAO, Flores EJ. Racial and Ethnic Disparities in Lung Cancer Screening Eligibility. Radiology 2021; 301:712-720. [PMID: 34546133 DOI: 10.1148/radiol.2021204691] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background To address disparities in lung cancer screening (LCS) that may exclude large numbers of high-risk African American smokers, revised U.S. Preventive Services Task Force (USPSTF) recommendations lowered LCS eligibility thresholds. However, there are limited recent data about the impact of newly revised guidelines on disparities in LCS eligibility. Purpose To evaluate the impact of revised USPSTF guidelines on racial and ethnic disparities in LCS eligibility. Materials and Methods Cross-sectional survey data from 20 states were retrospectively evaluated from the 2019 Behavioral Risk Factor Surveillance System survey (median response rate, 49.4%). Respondents without a history of lung cancer aged 55-79 years (ie, under the previous guidelines) or aged 50-79 years (ie, under the revised guidelines) were included. Multivariable logistic regression analyses were performed to evaluate the association between race and ethnicity and LCS eligibility. All analyses were performed accounting for complex survey design features (ie, weighting, stratification, and clustering). Results Under previous guidelines, 11% of 67 567 weighted survey respondents were eligible for LCS (White [12%], Hispanic [4%], African American [7%], American Indian [17%], Asian or Pacific Islander [4%], and other [12%]). Under revised USPSTF guidelines, 14% of 77 689 weighted survey respondents were eligible for LCS (White [15%], Hispanic [5%], African American [9%], American Indian [21%), Asian or Pacific Islander [5%], and other [18%]). Compared with White respondents, African American respondents (adjusted odds ratio [OR] = 0.36; 95% CI: 0.27, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.09, 0.24; P < .001) were less likely to be eligible for LCS under previous guidelines. African American respondents (adjusted OR = 0.39; 95% CI: 0.32, 0.47; P < .001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.10, 0.23; P < .001) were less likely to be eligible under the revised guidelines. The Wald test showed no evidence of differences in the degree to which racial and ethnic minority groups were less likely to be eligible for LCS when comparing previous versus revised USPSTF guidelines (P = .76). Conclusion The revised U.S. Preventive Services Task Force guidelines (version 2.0) may perpetuate lung cancer disparities, as racial and ethnic minority groups are still less likely to be eligible for lung cancer screening. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Jacobs and Springfield in this issue.
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Affiliation(s)
- Anand K Narayan
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Divya N Chowdhry
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Florian J Fintelmann
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Brent P Little
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Jo-Anne O Shepard
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
| | - Efrén J Flores
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114
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Jaramillo-Cardoso A, Daye D, Narayan AK, Spalluto LB, Alvarez C, Rosman DA, Brink JA, Flores EJ. A health disparities research framework to guide a radiology response to achieve equitable care during crisis. Clin Imaging 2021; 79:296-299. [PMID: 34385087 PMCID: PMC8452275 DOI: 10.1016/j.clinimag.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Adrian Jaramillo-Cardoso
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America; Veterans Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, TN, United States of America.
| | - Carmen Alvarez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - David A Rosman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
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Narayan AK, Pourvaziri A, Lopez DB, Miles RC, Kambadakone A, Flores EJ. Using CT Encounters to Improve Colorectal Cancer Screening Utilization: Cross-Sectional Survey Results From the National Health Interview Survey. Curr Probl Diagn Radiol 2021; 50:332-336. [DOI: 10.1067/j.cpradiol.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 12/31/2022]
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Narayan AK, Schaefer PW, Daye D, Alvarez C, Chonde DB, McLoud TC, Flores EJ, Brink JA. Practical Tips for Creating a Diversity, Equity, and Inclusion Committee: Experience From a Multicenter, Academic Radiology Department. J Am Coll Radiol 2021; 18:1027-1037. [PMID: 33915120 DOI: 10.1016/j.jacr.2021.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Coronavirus disease 2019 and the publicly documented deaths of countless Black individuals have highlighted the need to confront systemic racism, address racial/ethnic disparities, and improve diversity and inclusion in radiology. Several radiology departments have begun to create diversity, equity, and inclusion (DEI) committees to systematically address DEI issues in radiology. However, there are few articles that provide departments with guidance on how to create DEI committees to comprehensively address DEI issues in radiology. The purpose of this review is to provide readers with a framework and practical tips for creating a comprehensive, institutionally aligned radiology DEI committee. METHODS The authors describe key components of the strategic planning process and lessons learned in the creation of a radiology DEI committee, on the basis of the experience of an integrated, academic northeastern radiology department. RESULTS A hospital-based strategic planning process defining the DEI vision, mission, goals, and strategies was used to inform the formation of the radiology department DEI committee. The radiology department performed gap analyses by conducting internal and external research. Strengths, weaknesses, opportunities, and threats analyses were performed on the basis of consultations with institutional and other departmental DEI leaders as well as DEI leaders from other academic medical centers. This framework served as the basis for the creation of the radiology departmental DEI committee, including a steering committee and four task forces (education, research, patient experience, and workforce development), each charged with addressing specific institutional goals and strategies. CONCLUSIONS This review provides academic radiology departments with a blueprint to create a comprehensive, institutionally aligned radiology DEI committee.
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Affiliation(s)
- Anand K Narayan
- Assistant Professor, Harvard Medical School Quality and Safety Officer, Division of Breast Imaging, Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Pamela W Schaefer
- Vice Chair, Post Graduate Education and Fellowship Training, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dania Daye
- Co-Chair, Diversity Committee, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carmen Alvarez
- Program Director, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel B Chonde
- Co-Chair, Education Subcommittee, MGH Radiology Diversity Committee, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theresa C McLoud
- Program Director, MGH Radiology Residency Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Efren J Flores
- Community Health Officer, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James A Brink
- Chair, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Gupta Y, Narayan AK, Swope M, Siswick J, Beavers K, Patel AK. The Silent Rise of Radiology Instagram: A Longitudinal, Cross-Sectional Analysis. J Am Coll Radiol 2021; 18:1208-1212. [PMID: 33905750 DOI: 10.1016/j.jacr.2021.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/13/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yasha Gupta
- Department of Radiology, Mount Auburn Hospital, Cambridge, Massachusetts.
| | - Anand K Narayan
- Assistant Professor, Harvard Medical School, Quality and Safety Officer, Division of Breast Imaging, Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jessica Siswick
- Journal of the American College of Radiology, Reston, Virginia
| | | | - Amy K Patel
- Department of Radiology, Liberty Hospital/Alliance Radiology, Liberty, Missouri
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Villa Camacho JC, Pena MA, Flores EJ, Little BP, Parikh Y, Narayan AK, Miles RC. Addressing Linguistic Barriers to Care: Evaluation of Breast Cancer Online Patient Educational Materials for Spanish-Speaking Patients. J Am Coll Radiol 2021; 18:919-926. [PMID: 33676914 DOI: 10.1016/j.jacr.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the readability of breast cancer online patient educational materials (OPEM) written in Spanish and to compare to equivalent English-language OPEM. METHODS The breast cancer-related terms cáncer de seno (breast cancer), detección de cáncer de seno (breast cancer screening), and biopsia de seno (breast biopsy) were queried using an online search engine. After each query, educational information related to the queried term was downloaded from each website appearing on the first five search engine result pages. Readability of Spanish-language OPEM was evaluated using the Crawford reading grade score. When available, equivalent English-language OPEM from the same website was then evaluated using the mean of five validated readability indices. Differences in readability, word count, and reading time between Spanish- and English-language OPEM were compared using an unpaired t test. The Fisher exact test was used to compare the proportion of websites meeting AMA recommendations for patient educational resources. RESULTS Queries for cáncer de seno, detección de cáncer de seno, and biopsia de seno yielded 27, 31, and 30 results of term-specific OPEM. Equivalent English-language versions were available for 19 (70.4%), 18 (58.1%), and 20 (66.7%) websites, respectively. Spanish-language OPEM were written at a lower grade reading level than equivalent English-language versions overall (5.49 ± 0.50 versus 7.77 ± 1.95, P < .01). Spanish-language OPEM were also more likely than English-language OPEM to meet AMA recommendations (82.9% versus 40.4%, P < .01). CONCLUSIONS Breast cancer-related Spanish-language OPEM were written at a significantly lower grade reading level compared with equivalent information written in English.
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Affiliation(s)
| | - Miguel A Pena
- Harvard Kennedy School of Government, Cambridge, Massachusetts
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Officer, Radiology Community Health Improvement, Massachusetts General Hospital, Boston, Massachusetts
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Assistant Director, Radiology Resident Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yasha Parikh
- Chief Resident, Diagnostic Radiology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Anand K Narayan
- Co-Chair, Radiology Diversity, Equity & Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Randy C Miles
- Education Director, Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Chonde DB, Pourvaziri A, Williams J, McGowan J, Moskos M, Alvarez C, Narayan AK, Daye D, Flores EJ, Succi MD. RadTranslate: An Artificial Intelligence-Powered Intervention for Urgent Imaging to Enhance Care Equity for Patients With Limited English Proficiency During the COVID-19 Pandemic. J Am Coll Radiol 2021; 18:1000-1008. [PMID: 33609456 PMCID: PMC7847389 DOI: 10.1016/j.jacr.2021.01.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
Purpose Disproportionally high rates of coronavirus disease 2019 (COVID-19) have been noted among communities with limited English proficiency, resulting in an unmet need for improved multilingual care and interpreter services. To enhance multilingual care, the authors created a freely available web application, RadTranslate, that provides multilingual radiology examination instructions. The purpose of this study was to evaluate the implementation of this intervention in radiology. Methods The device-agnostic web application leverages artificial intelligence text-to-speech technology to provide standardized, human-like spoken examination instructions in the patient’s preferred language. Standardized phrases were collected from a consensus group consisting of technologists, radiologists, and ancillary staff members. RadTranslate was piloted in Spanish for chest radiography performed at a COVID-19 triage outpatient center that served a predominantly Spanish-speaking Latino community. Implementation included a tablet displaying the application in the chest radiography room. Imaging appointment duration was measured and compared between pre- and postimplementation groups. Results In the 63-day test period after launch, there were 1,267 application uses, with technologists voluntarily switching exclusively to RadTranslate for Spanish-speaking patients. The most used phrases were a general explanation of the examination (30% of total), followed by instructions to disrobe and remove any jewelry (12%). There was no significant difference in imaging appointment duration (11 ± 7 and 12 ± 3 min for standard of care versus RadTranslate, respectively), but variability was significantly lower when RadTranslate was used (P = .003). Conclusions Artificial intelligence–aided multilingual audio instructions were successfully integrated into imaging workflows, reducing strain on medical interpreters and variance in throughput and resulting in more reliable average examination length.
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Affiliation(s)
- Daniel B Chonde
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ali Pourvaziri
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Joy Williams
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer McGowan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Margo Moskos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Carmen Alvarez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Assistant Professor Harvard Medical School, Boston, Massachusetts; Quality and Safety Officer, Division of Breast Imaging; Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology Massachusetts General Hospital, Boston Massachusetts
| | - Dania Daye
- Harvard Medical School, Boston, Massachusetts; Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology Massachusetts General Hospital
| | - Efren J Flores
- Harvard Medical School, Boston, Massachusetts; Faculty, The Mongan Institute, Officer, Radiology Community Health and Equity, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Director, Medically Engineered Solutions in Healthcare Incubator, Massachusetts General Hospital Radiology, Harvard Medical School, Boston, Massachusetts.
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Miles RC, Flores EJ, Lopez DB, Sohn YJ, Gillis EA, Lehman CD, Narayan AK. Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence. J Am Coll Radiol 2021; 18:834-840. [PMID: 33497614 DOI: 10.1016/j.jacr.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions. METHODS Adult participants from the 2015 National Health Interview Survey were included. Among patients nonadherent to national breast, colorectal, or lung cancer screening guidelines, the proportion of patients reporting an ED visit within the last year was estimated, accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and screening adherence. RESULTS Of screening eligible respondents, 17.2% of women nonadherent to mammography screening, 16.9% of patients nonadherent to colorectal cancer screening, and 25.0% of patients nonadherent to lung cancer screening reported at least one ED visit in the preceding year. Patients visiting the ED with postsecondary school education were more likely to be up to date with mammography screening than those without advanced education (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.21-1.74; P = .01). Patients without insurance were less likely than those with insurance to report being up to date with both mammography screening (OR 0.31; 95% CI: 0.21-0.48; P = .01) and colorectal cancer screening (OR 0.56; 95% CI: 0.34-0.93; P = .03). DISCUSSION Opportunities to improve cancer screening adherence exist through ED-based preventative care interventions, which leverage multidisciplinary partnerships, including radiologists, to reach large volumes of patients who are not engaged in cancer screening.
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Affiliation(s)
- Randy C Miles
- Education Director, Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Officer, Radiology Community Health Improvement, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Eleanor A Gillis
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Division Chief of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Co-chair, Radiology Diversity, Equity & Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Wang GX, Chou SHS, Lamb LR, Narayan AK, Dontchos BN, Lehman CD, Miles RC. Opportunities for Radiology Trainee Education Amid the COVID-19 Pandemic: Lessons From an Academic Breast Imaging Program. Acad Radiol 2021; 28:136-141. [PMID: 33036896 PMCID: PMC7532749 DOI: 10.1016/j.acra.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic required restructuring of Radiology trainee education across US institutions. While reduced clinical imaging volume and mandates to maintain physical distancing presented new challenges to traditional medical education during this period, new opportunities developed to support our division in providing high-quality training for residents and fellows. The Accreditation Council for Graduate Medical Education (ACGME) Core Competencies for Diagnostic Radiology helped guide division leadership in restructuring and reframing breast imaging education during this time of drastic change and persistent uncertainty. Here, we reflect on the educational challenges and opportunities faced by our academic breast imaging division during the height of the COVID-19 pandemic across each of the ACGME Core Competencies. We also discuss how systems and processes developed out of necessity during the first peak of the pandemic may continue to support radiology training during phased reopening and beyond.
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Affiliation(s)
- Gary X Wang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696
| | - Shinn-Huey S Chou
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696
| | - Leslie R Lamb
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696
| | - Randy C Miles
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696.
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Joseph NP, Reid NJ, Som A, Li MD, Hyle EP, Dugdale CM, Lang M, Betancourt JR, Deng F, Mendoza DP, Little BP, Narayan AK, Flores EJ. Racial and Ethnic Disparities in Disease Severity on Admission Chest Radiographs among Patients Admitted with Confirmed Coronavirus Disease 2019: A Retrospective Cohort Study. Radiology 2020; 297:E303-E312. [PMID: 32673191 PMCID: PMC7370353 DOI: 10.1148/radiol.2020202602] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Disease severity on chest radiographs has been associated with higher risk of disease progression and adverse outcomes from coronavirus disease 2019 (COVID-19). Few studies have evaluated COVID-19-related racial and/or ethnic disparities in radiology. Purpose To evaluate whether non-White minority patients hospitalized with confirmed COVID-19 infection presented with increased severity on admission chest radiographs compared with White or non-Hispanic patients. Materials and Methods This single-institution retrospective cohort study was approved by the institutional review board. Patients hospitalized with confirmed COVID-19 infection between March 17, 2020, and April 10, 2020, were identified by using the electronic medical record (n = 326; mean age, 59 years ±17 [standard deviation]; male-to-female ratio: 188:138). The primary outcome was the severity of lung disease on admission chest radiographs, measured by using the modified Radiographic Assessment of Lung Edema (mRALE) score. The secondary outcome was a composite adverse clinical outcome of intubation, intensive care unit admission, or death. The primary exposure was the racial and/or ethnic category: White or non-Hispanic versus non-White (ie, Hispanic, Black, Asian, or other). Multivariable linear regression analyses were performed to evaluate the association between mRALE scores and race and/or ethnicity. Results Non-White patients had significantly higher mRALE scores (median score, 6.1; 95% confidence interval [CI]: 5.4, 6.7) compared with White or non-Hispanic patients (median score, 4.2; 95% CI: 3.6, 4.9) (unadjusted average difference, 1.8; 95% CI: 0.9, 2.8; P < .01). For both White (adjusted hazard ratio, 1.3; 95% CI: 1.2, 1.4; P < .001) and non-White (adjusted hazard ratio, 1.2; 95% CI: 1.1, 1.3; P < .001) patients, increasing mRALE scores were associated with a higher likelihood of experiencing composite adverse outcome with no evidence of interaction (P = .16). Multivariable linear regression analyses demonstrated that non-White patients presented with higher mRALE scores at admission chest radiography compared with White or non-Hispanic patients (adjusted average difference, 1.6; 95% CI: 0.5, 2.7; P < .01). Adjustment for hypothesized mediators revealed that the association between race and/or ethnicity and mRALE scores was mediated by limited English proficiency (P < .01). Conclusion Non-White patients hospitalized with coronavirus disease 2019 infection were more likely to have a higher severity of disease on admission chest radiographs than White or non-Hispanic patients, and increased severity was associated with worse outcomes for all patients. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
| | | | - Avik Som
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Matthew D Li
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Emily P. Hyle
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Caitlin M. Dugdale
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Min Lang
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Joseph R. Betancourt
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Francis Deng
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Dexter P. Mendoza
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Brent P. Little
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Anand K. Narayan
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
| | - Efren J. Flores
- Harvard Medical School, Boston, MA (N.P.J., N.J.R.); Department of Radiology, Massachusetts General Hospital, Boston, MA (A.S., M.D.L., M.L., F.D., D.P.M., B.P.L., A.K.N., E.J.F.); Department of Medicine, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D., J.R.B.); Department of Infectious Diseases, Massachusetts General Hospital, Boston, MA (E.P.H., C.M.D.); Office of Vice President and Chief Equity and Inclusion Officer, Massachusetts General Hospital, Boston, MA (J.R.B.)
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Narayan AK, Gupta Y, Little BP, Shepard JO, Flores EJ. Lung cancer screening eligibility and use with low-dose computed tomography: Results from the 2018 Behavioral Risk Factor Surveillance System cross-sectional survey. Cancer 2020; 127:748-756. [PMID: 33206388 DOI: 10.1002/cncr.33322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND In randomized controlled trials, lung cancer screening with low-dose chest computed tomography (LCS) has been reported to reduce lung cancer mortality. Although initial studies suggested that only approximately 5% of eligible patients have undergone LCS, recent studies have indicated that use of LCS may be increasing nationwide. The objective of the current study was to estimate recent LCS use using cross-sectional survey data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey. METHODS The BRFSS is a nationally representative, cross-sectional telephone survey of adults in the United States (response rate of approximately 50%). The 2018 BRFSS survey included questions regarding LCS eligibility and use in 8 states. The primary outcome was the percentage of participants (aged 55-79 years with a smoking history of >30 pack-years) who reported undergoing LCS. Logistic regression analyses evaluated the association between LCS use and sociodemographic characteristics, adjusted for potential confounders and accounting for complex survey design elements. RESULTS A total of 26,910 participants were included, 9.9% of whom were eligible for LCS (95% CI, 8.8%-10.6%). Of the eligible patients, 19.2% reported undergoing LCS (95% CI, 14.0%-24.4%). Approximately 16.4% of current smokers were eligible for LCS (95% CI, 14.2%-18.6%). In our multiple variable analyses of eligible patients, age, sex, marital status, current smoking status, and race were not found to be associated with statistically significant differences in reported LCS (P > .05). Retired patients, patients with personal physicians, and patients who did not complete a high school education were more likely to report receiving LCS (P < .05). CONCLUSIONS Compared with previously published studies, the results of the current study suggested that LCS use is increasing. However, LCS use remains low (19%) among eligible participants.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yasha Gupta
- Department of Radiology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanne O Shepard
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
Among women, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death in the world. The purpose of this article is to review the evidence regarding breast cancer screening for average-risk women. The review primarily focuses on mammographic screening but also reviews clinical breast examinations, emerging screening technologies, and opportunities to build consensus. Wherever possible, the review relies on published systematic reviews, meta-analyses, and guidelines from three major societies (US Preventive Services Task Force, American College of Radiology, and the American Cancer Society) to reflect a range of evidence-based perspectives regarding mammographic screening.
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Affiliation(s)
- Anand K Narayan
- Radiology, Massachusetts General Hospital, 55 Fruit Street, Wang 240, Boston, MA 02114, USA. https://twitter.com/AnandKNarayan
| | - Christoph I Lee
- Department of Radiology, Department of Health Services, Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, 1144 Eastlake Avenue East, LG-212, Seattle, WA 98109, USA
| | - Constance D Lehman
- Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang Building, Suite 219L, Boston, MA 02114, USA
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Wang GX, Neil JM, Fintelmann FJ, Little BP, Narayan AK, Flores EJ. Guideline-Discordant Lung Cancer Screening: Emerging Demand and Provided Indications. J Am Coll Radiol 2020; 18:395-405. [PMID: 32905787 DOI: 10.1016/j.jacr.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE It is unclear whether patients and providers have started to knowingly request lung cancer screening (LCS) outside US guidelines and insurance coverage for risk factors besides a history of heavy smoking. The authors analyzed their institution's best practices advisory (BPA) clinical decision support system to determine whether providers knowingly order guideline-discordant LCS and the indications given. METHODS CT examinations ordered for LCS at an academic medical center that triggered BPA alerts from November 2018 to December 2019 were reviewed. Alerts were triggered by attempts to order examinations outside Medicare coverage, which resembles most US guidelines. Providers can override alerts to order the examinations. Primary outcomes were the number of examinations performed using orders with overridden BPA alerts and indications given. Qualitative exploratory and directed content analyses identified motivators and decision-making processes that drove guideline-discordant screening use. RESULTS Forty-two patients underwent guideline-discordant LCS, constituting 1.9% of all patients screened (42 of 2,248): 42.9% (18 of 42) were <54 or >77 years old, 14.3% (6 of 42) had never smoked, 40.5% (17 of 42) had quit >15 years earlier, and 31% (13 of 42) had smoked <30 pack-years; 45.2% (19 of 42) fell outside all US guidelines. The most common indication was a family history of lung cancer (21.4% [9 of 42]). Perceptions of elevated cancer risk from both patients and referring providers drove guideline-discordant screening use. CONCLUSIONS Referring providers knowingly ordered screening CT examinations outside Medicare coverage and US guidelines, including for never smokers, for indications including a family history of lung cancer. LCS programs may need tailored strategies to guide these patients and providers, such as help with cancer risk assessment.
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Affiliation(s)
- Gary X Wang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jordan M Neil
- Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Brent P Little
- Associate Residency Program Director, Department of Radiology, Massachusetts General Hospital, Boston, Masachussetts
| | - Anand K Narayan
- Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massacusetts
| | - Efren J Flores
- Faculty, The Mongan Institute, Officer, Radiology Community Health and Equity, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Stowell JT, Narayan AK, Wang GX, Fintelmann FJ, Flores EJ, Sharma A, Petranovic M, Shepard JAO, Little BP. Factors affecting patient adherence to lung cancer screening: A multisite analysis. J Med Screen 2020; 28:357-364. [PMID: 32847462 DOI: 10.1177/0969141320950783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify factors associated with delayed adherence to follow-up in lung cancer screening. METHODS Utilizing a data warehouse and lung cancer screening registry, variables were collected from a referred sample of 3110 unique participants with follow-up CT during the study period (1 January 2016 to 17 October 2018). Adherence was defined as undergoing chest CT within 90 days and 30 days of the recommended time for follow-up and was determined using proportions and multiple variable logistic regression models across the American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS®) categories. RESULTS Of 1954 lung cancer screening participants (51.9% (1014/1954) males, 48.1% (940/1954) female; mean age 65.7 (range 45-87), smoking history median 40 pack-years, 60.2% and 44.5% did not follow-up within 30 and 90 days, respectively. Participants receiving Lung-RADS® category 1 or 2 presented later than those with Lung-RADS® category 3 at 90 days (coefficient -27.24, 95% CI -51.31, -3.16, p = 0.027). Participants with Lung-RADS® category 1 presented later than those with Lung-RADS® category 2 at both 90- and 30-days past due (OR 0.76 95% CI [0.59-0.97], p = 0.029 and OR 0.63 95% CI [0.48-0.83], p = 0.001, respectively). CONCLUSIONS Adherence to follow-up was higher among participants receiving more suspicious Lung-RADS® results at index screening CT and among those who had undergone more non-lung cancer screening imaging examinations prior to index lung cancer screening CT. These observations may inform strategies aimed at prospectively identifying participants at risk for delayed or nonadherence to prevent potential morbidity and mortality from incident lung cancers.
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Affiliation(s)
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Gary X Wang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Whorms DS, Narayan AK, Pourvaziri A, Miles RC, Glover M, Herrington J, Saini S, Brink JA, Flores EJ. Analysis of the Effects of a Patient-Centered Rideshare Program on Missed Appointments and Timeliness for MRI Appointments at an Academic Medical Center. J Am Coll Radiol 2020; 18:240-247. [PMID: 32791235 DOI: 10.1016/j.jacr.2020.05.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to assess the differences in timeliness to MRI appointments and missed MRI appointment rates before and after the implementation of a rideshare program. METHODS Retrospective analysis of a rideshare program was performed 9 months after implementation to compare the effects before and after implementation. Variables obtained included demographics, MRI appointment variables, and data related to rideshare use. Descriptive statistics and linear and logistic regression analyses were used to compare demographic characteristics among patients using the rideshare program with (1) those who did not use the rideshare program after implementation and (2) patients before rideshare implementation. Rates of missed appointments derived from patient-related, same-day appointment cancellations were analyzed using logistic regression analyses. Timeliness was analyzed using linear regression analyses. All analyses were adjusted for potential confounders. RESULTS Of 7,707 patients scheduled for MRI appointments during the postintervention period, 151 patients used the rideshare service (1.95%). There were no statistically significant differences in missed appointment rates after rideshare implementation (adjusted odds ratio, 1.09; 95% confidence interval, 0.93-1.27; P = .275). Patients using the rideshare service were more likely to be on time (adjusted coefficient = 13.0; 95% confidence interval, 5.4-20.5; P = .001). Older patients (P = .001), unemployed patients (P < .001), and patients without commercial insurance (P < .001) were more likely to use the rideshare service. CONCLUSIONS Implementation of a rideshare program did not significantly decrease missed appointment rates, but it significantly improved timeliness to MRI appointments while assisting at-risk patient populations reporting transportation barriers.
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Affiliation(s)
- Debra S Whorms
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anand K Narayan
- Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massacusetts
| | - Ali Pourvaziri
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeremy Herrington
- Director of Clincal Operations, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sanjay Saini
- Vice-chair for Finance and Quality, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - James A Brink
- Juan M. Taveras Professor of Radiology; Radiologist-in-Chief, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Faculty, The Mongan Institute, Officer, Radiology Community Health and Equity, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Stowell JT, Parikh Y, Tilson K, Narayan AK. Lung Cancer Screening Eligibility and Utilization Among Transgender Patients: An Analysis of the 2017–2018 United States Behavioral Risk Factor Surveillance System Survey. Nicotine Tob Res 2020; 22:2164-2169. [DOI: 10.1093/ntr/ntaa127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Introduction
Transgender and gender diverse (TGD) persons disproportionately face many health disparities including a higher risk of lung cancer. Lung cancer screening (LCS) using low-dose chest computed tomography has reduced lung cancer mortality in eligible high-risk smokers across several large trials, yet utilization of LCS remains low. TGD persons may be less likely to receive recommended cancer screening compared with cisgender populations. We sought to compare eligibility for and utilization of LCS between TGD and cisgender persons in the United States. We also examined if the utilization of LCS varied by smoking status within each gender identity group.
Methods
We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional survey to determine eligibility and utilization of LCS among TGD participants compared with cisgender persons. Logistical regression analysis of potentially confounding variables included age category, race/ethnicity, income, employment status, health insurance, and having a personal doctor.
Results
Of 37 023 weighted respondents, 0.5% were TGD. Although eligibility for LCS was statistically similar (8.8% TGD vs. 12.2% cisgender) (adjusted odds ratio = 0.81, 95% confidence interval = 0.27–2.39, p = .703), only 2.3% of TGD participants reported obtaining a LCS chest computed tomography versus 17.2% of cisgender participants (adjusted odds ratio = 0.04, 95% confidence interval = 0.01–0.59, p = .019). Smoking status showed no association with LCS utilization among gender identity groups.
Conclusions
TGD persons may be less likely to receive LCS despite having similar smoking status and eligibility of cisgender persons, suggesting a disparity in utilization of this preventative health service.
Implications
Targeted efforts to increase LCS utilization and promote smoking cessation for at-risk TGD patients may be warranted.
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Affiliation(s)
| | - Yasha Parikh
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA
| | - Kimberly Tilson
- Behavioral Health Community Access Program, Truman Medical Centers, Kansas City, MO
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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Wang GX, Narayan AK, Park ER, Lehman CD, Gorenstein JT, Flores EJ. Screening Mammography Visits as Opportunities to Engage Smokers With Tobacco Cessation Services and Lung Cancer Screening. J Am Coll Radiol 2020; 17:606-612. [DOI: 10.1016/j.jacr.2019.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022]
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Febbo J, Little B, Fischl-Lanzoni N, Narayan AK, Tiersma KM, Glover M, Shepard JAO, Flores EJ. Analysis of Out-of-Pocket Cost of Lung Cancer Screening for Uninsured Patients Among ACR-Accredited Imaging Centers. J Am Coll Radiol 2020; 17:1108-1115. [PMID: 32278848 DOI: 10.1016/j.jacr.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the variability in out-of-pocket costs of lung cancer screening (LCS) for uninsured patients and assess accessibility of this information by telephone or Internet. METHODS LCS centers from the ACR's LCS database were randomly selected. Centers were called between July and August 2019 to determine out-of-pocket cost. Telephone call variables, accessibility of cost information on screening centers' websites, screening centers' chargemasters, and publicly available facility and state insurance coverage variables were obtained. Cost information was summarized using descriptive analyses. Multiple variable linear regression analyses were conducted to evaluate effects of facility and state-level characteristics on out-of-pocket costs. RESULTS Fifty-five ACR-accredited LCS centers were included with 78% (43 of 55) willing to provide out-of-pocket cost. Average out-of-pocket cost was $583 ± $607 (mean ± standard deviation), range $49 to $2,409. Average telephone call length 6 ± 3.8 min. Two of fifty-five screening centers' websites provided out-of-pocket cost information, and one matched cost given over the telephone. A chargemaster was found for 30 of 55 screening centers. No statistically significant differences in out-of-pocket costs were found by geographic region, state percentages of uninsured residents, state percentages of residents with public insurance, or facility safety net hospital affiliation. DISCUSSION Out-of-pocket LCS costs for uninsured patients and availability of this information is highly variable. Radiology practices should be aware of this variability that may influence participation rates among uninsured patients.
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Affiliation(s)
- Jennifer Febbo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brent Little
- Harvard Medical School, Boston, Massachusetts; Associate Residency Program Director, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalia Fischl-Lanzoni
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand K Narayan
- Co-Chair, Diversity, Equity and Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Physicians Organization, Boston, Massachusetts
| | - Keenae M Tiersma
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Massachusetts General Physicians Organization, Boston, Massachusetts
| | - Jo-Anne O Shepard
- Massachusetts General Physicians Organization, Boston, Massachusetts; Director, Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, Massacusetts
| | - Efren J Flores
- Harvard Medical School, Boston, Massachusetts; Officer, Radiology Community Health & Equity, Massachusetts General Hospital, Boston, Massacusetts.
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Narayan AK, Al-Naemi H, Aly A, Kharita MH, Khera RD, Hajaj M, Rehani MM. Breast Cancer Detection in Qatar: Evaluation of Mammography Image Quality Using A Standardized Assessment Tool. Eur J Breast Health 2020; 16:124-128. [PMID: 32285034 DOI: 10.5152/ejbh.2020.5115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/01/2020] [Indexed: 11/22/2022]
Abstract
Objective Compared with other countries in the Middle East, Qatar has one of the highest breast cancer incidence and mortality rates. Poor quality mammography images may be associated with advanced stage breast cancer, however there is limited information about the quality of breast imaging in Qatar. Our purpose was to evaluate the clinical image quality of mammography examinations performed at a tertiary care center in Doha, Qatar using a standardized assessment tool. Materials and Methods Bilateral mammograms from consecutive patients from a tertiary care cancer center in Doha, Qatar were obtained. Proportions of examinations deemed adequate for interpretation were estimated. Standardized clinical image quality assessment form was utilized to evaluate image quality components. For each image, image quality components were given grades on a 1-5 scale (5-excellent, 4-good, 3-average, 2-fair, 1-poor). Mean scores with 95% confidence intervals were estimated for each component. Results Consecutive sample of 132 patients was obtained representing 528 mammographic images. Overall, 99.2% of patients underwent examinations rated as acceptable for interpretation. Mean scores for each image quality component ranged from 4.045 to 5.000 (lowest score for inframammary fold). Image quality component scores were 93.0% excellent, 5.2% good, 1.1% average, 0.6% fair, and 0.1% poor. Conclusion Overall image quality at a tertiary care center in Doha, Qatar was acceptable for interpretation with minimal areas identified for improvement.
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Affiliation(s)
| | | | - Antar Aly
- Hamad Medical Corporation, Doha, Qatar
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Lopez D, Miles RC, Flores EJ, Lehman CD, Narayan AK. Breast Cancer Screening in Puerto Rico and Other US Territories: Findings from the 2016 Behavioral Risk Factor Surveillance System Survey. J Health Care Poor Underserved 2020; 31:340-352. [PMID: 32037335 DOI: 10.1353/hpu.2020.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Initial studies suggest that women living in U.S. territories may experience barriers to appropriate breast cancer diagnosis and treatment. Our purpose was to evaluate mammography screening engagement in U.S. territories compared with U.S. states. Women aged 50-74 years in the 2016 Behavioral Risk Factor Surveillance System survey without personal history of breast cancer were included. Proportions of women reporting mammography use were calculated. Multivariable logistic regression models were used to compare self-reported mammography use in U.S. territories with all U.S. states. Our total study population included 131,320 women. Of this group, 2,481 were from U.S. territories. In our adjusted analyses, women in the U.S. Virgin Islands were less likely to report mammography use (OR 0.52) compared with women in the U.S. states. Women in other U.S. territories reported mammography at similar rates to U.S. states. Targeted interventions accounting for unique, territory-specific barriers are likely required to improve screening engagement.
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Narayan AK, Lehman CD. Mammography Screening Guideline Controversies: Opportunities to Improve Patient Engagement in Screening. J Am Coll Radiol 2020; 17:633-636. [PMID: 32027838 DOI: 10.1016/j.jacr.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Miles RC, Narayan AK, Lopez DB, Lehman CD, Harvey HB, Mishra V, Glover M, Flores EJ. Chronic Medical Illness as a Risk Factor for Poor Mammography Screening Adherence. J Womens Health (Larchmt) 2019; 28:1378-1383. [DOI: 10.1089/jwh.2018.7315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Randy C. Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K. Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B. Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - H. Benjamin Harvey
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J. Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Miles RC, Lehman CD, Mercaldo SF, Tamimi RM, Dontchos BN, Narayan AK. Obesity and breast cancer screening: Cross-sectional survey results from the behavioral risk factor surveillance system. Cancer 2019; 125:4158-4163. [PMID: 31393609 DOI: 10.1002/cncr.32430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. METHODS Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I (30-34.9 kg/m2 ), obese class II (35-39.9 kg/m2 ), and obese class III (>40 kg/m2 ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. RESULTS Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P < .05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P = .53). CONCLUSIONS In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rulla M Tamimi
- Channing Institute, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Dontchos BN, Narayan AK, Seidler M, Mercaldo SF, Miles RC, Ebert E, Lehman CD. Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy. J Am Coll Radiol 2019; 16:1554-1560. [PMID: 31152690 DOI: 10.1016/j.jacr.2019.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Disparities in breast cancer diagnosis are established. In usual practice, biopsies are performed days or weeks after recommendation. Our aim was to measure the impact of a same-day biopsy program on disparities in time from biopsy recommendation to performance. METHODS After Institutional Review Board approval, we identified all diagnostic examinations leading to biopsy pre- (September 2016 to March 2017) and post- (September 2017 to March 2018) implementation of our same-day biopsy program. We compared demographic characteristics (age, race, language, and insurance) and biopsy information (days from biopsy recommendation to biopsy, and proportion of same-day biopsies in all biopsies) in pre- versus postimplementation groups. Multivariable linear and logistic models in pre- and postimplementation groups assessed if days from biopsy recommendation to biopsy and having a same-day biopsy were associated with patient subgroups. RESULTS In all, 663 and 482 patients underwent biopsy during pre- and postimplementation periods, respectively. Patient subgroups were similar between periods. For all patients, the same-day biopsy program decreased median time from diagnostic examination to biopsy from 8 (interquartile range: 4-13) to 0 (interquartile range: 0-4) days (P < .001). During the pre-implementation period, nonwhite patients and having Medicare insurance were associated with longer days to biopsy (nonwhite Adjusted Coefficient: 2.31, 95% confidence interval [CI]: 0.58-4.03; insurance Adjusted Coefficient: 2.47, 95% CI: 0.58-4.37; P < .05), after adjustment. During the postimplementation period, the previously seen disparities did not persist (nonwhite Adjusted Coefficient: -0.416, 95% CI: -2.16-1.33; insurance Adjusted Coefficient: 0.812, 95% CI: -1.18-2.80; P > .05). CONCLUSION There was no evidence of racial/ethnic or insurance disparities in time from biopsy recommendation to performance after implementation of a same-day biopsy program.
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Affiliation(s)
| | | | | | | | - Randy C Miles
- Massachusetts General Hospital, Boston, Massachusetts
| | - Emily Ebert
- Massachusetts General Hospital, Boston, Massachusetts
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