The availability of digital breast tomosynthesis (DBT) is similar across neighborhoods with high or low deprivation, according to findings published April 17 in the Journal of the American College of Radiology. 

Researchers led by Cassie Deshong from Dartmouth University in Hanover, NH, found that despite these similarities, breast imaging facilities in low-deprivation areas are more likely to offer weekend DBT appointments, and similar costs may affect residents of these neighborhoods differently. 

“Geographic availability alone is not sufficient to ensure equitable access to DBT services; complementary strategies such as cost-reduction policies and expanded scheduling are needed to improve DBT uptake in underserved populations,” Deshong and colleagues wrote. 

While most U.S. Food and Drug Administration (FDA)-certified breast imaging facilities offer DBT, recent studies suggest that DBT access by geographic area is not equitable. Factors leading to these disparities are based on race, ethnicity, geography, and socioeconomic factors, with historically underserved populations having limited access to DBT. 

Researchers at the Center for Health Disparities Research, part of the University of Wisconsin, launched the Neighborhood Atlas in 2018 to host the Area Deprivation Index (ADI). The ADI is a validated tool that quantifies neighborhood-level socioeconomic disadvantages based on 17 factors from the U.S. Census Bureau’s American Community Survey. Among others, these include income, education, employment, and housing quality.  

“Therefore, ADI can be used as a proxy to determine neighborhood resource deprivation at the zip code level,” the researchers wrote. 

The Deshong team evaluated potential ties between zip code level neighborhood deprivation and availability to DBT at breast imaging facilities accredited by the FDA. 

The study included 220 randomly-sampled breast imaging facilities, of which 202 (91.8%) reported having DBT available. The team reported no significant differences in the overall availability of DBT, after-hours evening appointments, and transportation services between facilities in low- and high-deprivation areas.  

The study also analyzed 77 facilities that had DBT fees. The researchers reported a median cost of $250, with no significant difference in average fees across ADI zip codes.  

However, facilities in high-deprivation areas did not offer DBT services on weekends as frequently as those in low-deprivation areas (23.1% versus 50%, p

“Compared with high-deprivation areas, facilities in low-deprivation areas also more frequently significantly offered online scheduling,” the study authors wrote. 

And while the study found no significant differences in co-payments and out-of-pocket expenses between areas, these costs “may disproportionately impact women from lower socioeconomic backgrounds leading to lower utilization rates seen in prior studies,” the authors added. 

The team called for future research to study how increasing physician engagement, reducing patient costs, and expanding scheduling availability could tie into DBT use.  

“In addition, a patient focused study should be conducted to gain better insight into how patient specific factors influence DBT access,” it wrote. 

Read the full study here.