Disparities in the use of screening breast magnetic resonance imaging persist in Louisiana after the Affordable Care Act: A question of access, policy, institutional support, or something else?

• Published in: Cancer 2023-03, Vol.129 (6), p.829-833
• Main Authors: Morrell, Brooke L., Morrell, Mignonne B., Ball, Jane A., Ochoa, Augusto C., Seewaldt, Victoria L.
• Format: Article
• Language: English
• Subjects: abbreviated magnetic resonance imaging; Black people; Breast cancer; breast cancer disparities; breast cancer screening; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - prevention & control; Cancer screening; Early Detection of Cancer - methods; Female; Government programs; Humans; Louisiana - epidemiology; Louisiana Affordable Care Act; Magnetic Resonance Imaging; Mammography; Medical imaging; Medical screening; Mortality; Oncology; Organizational Policy; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act; screening breast magnetic resonance imaging; Technology; United States
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34605

Background Louisiana continues to have one of the highest breast cancer mortality rates in the nation, and Black women are disproportionally affected. Louisiana has made advances in improving access to breast cancer screening through the expansion of Medicaid. There remains, however, broad underuse of advanced imaging technology such as screening breast magnetic resonance imaging (MRI), particularly for Black women. Methods Breast MRI has been proven to be very sensitive for the early detection of breast cancer in women at high risk. MRI is more sensitive than mammography for aggressive, invasive breast cancer types, which disproportionally affect Black women. Here the authors identify potential barriers to breast MRI screening in Black women, propose strategies to address disparities in access, and advocate for specific recommendations for change. Results Cost was identified as one of the greatest barriers to screening breast MRI. The authors propose implementation of cost‐saving, abbreviated protocols to address cost along with lobbying for further expansion of the Affordable Care Act (ACA) to include coverage for screening breast MRI. In addition, addressing gaps in communication and knowledge and facilitating providers’ ability to readily identify women who might benefit from MRI could be particularly impactful for high‐risk Black women in Louisiana communities. Conclusions Since the adoption of the ACA in Louisiana, Black women have continued to have disproportionally high breast cancer mortality rates. This persistent disparity provides evidence that additional change is needed. This change should include exploring innovative ways to make advanced imaging technology such as breast MRI more accessible and expanding research to specifically address community and culturally specific barriers. Disparities in breast cancer mortality have persisted since the adoption of the Affordable Care Act in Louisiana despite increased access to screening. Increased access to screening has not translated into an increase in screening magnetic resonance imaging, which is a highly sensitive imaging tool for the detection of aggressive breast cancers and can be greatly beneficial to certain high‐risk patient populations.