Disparities in Same-Day Diagnostic Imaging in Breast Cancer Screening: Impact of an Immediate-Read Screening Mammography Program Implemented During the COVID-19 Pandemic.

Background: The need for second visits between screening mammograms and diagnostic imaging contributes to disparities in the time to breast cancer diagnosis. During the COVID-19 pandemic, we implemented an immediate-read screening mammography program to reduce patient visits and decrease time to diagnostic imaging. Objective: To measure the impact of an immediate-read screening program, with focus on disparities in sameday diagnostic imaging after abnormal screening mammograms. Methods: In May 2020, we implemented an immediate-read screening program whereby a dedicated breast imaging radiologist interprets all screening mammograms in real-time; patients receive results before discharge, and efforts are made to perform any recommended diagnostic imaging during the visit (performed by different radiologists). We retrospectively identified screening mammograms performed from 6/1/2019-10/31/2019 (pre-implementation) or 6/1/2020-10/31/2020 (post-implementation). Patient characteristics were recorded from the electronic medical record. Multivariable logistic regression models incorporating patient age, race and ethnicity, language, and insurance type were estimated to identify factors associated with same-day diagnostic imaging. Screening metrics were compared between periods. Results: A total of 8,222 pre-implementation and 7,235 post-implementation screening examinations were included; 521 and 359 patients had abnormal screening examinations, respectively. A total of 14.8% and 60.7% of patients, respectively, had same-day diagnostic imaging after abnormal screening mammograms. Pre-implementation, patients with other races had significantly lower odds than White patients of same-day diagnostic imaging after abnormal screening examinations (adjusted odds ratio: 0.30; 95% CI: 0.10, 0.86; p=.03). Post-implementation, odds of same-day diagnostic imaging was not significantly different between patients with other races and White patients (adjusted odds ratio: 0.92; 95% CI: 0.50, 1.71; p=.80). Post-implementation, patients with and without same-day diagnostic imaging after abnormal screening mammograms showed no significant difference in race and ethnicity (p>.05). Abnormal interpretation rate was significantly lower post-implementation than pre-implementation (5.0% vs 6.3%, respectively; p .05) in cancer detection rate or PPV1. Conclusion: The immediate-read screening mammography program reduced prior racial and ethnic disparities in same-day diagnostic imaging after abnormal screening mammograms. Clinical Impact: An immediate-read screening program provides a new paradigm for improved screening mammography workflow that allows more rapid diagnostic workup with reduced care disparities.