Potential missed detection with screening mammography: does the quality of radiologist’s interpretation vary by patient socioeconomic advantage/disadvantage?

PURPOSE: We examined whether quality of mammography interpretation as performed by the original reading radiologist varied by patient sociodemographic characteristics. METHODS: For 149 patients residing in Chicago and diagnosed in 2005‐2008, we obtained the original index mammogram that detected the breast cancer and at least one prior mammogram that did not detect the cancer performed within 2 years of the index mammogram. A single breast imaging specialist performed a blinded review of the prior mammogram. Potentially missed detection was defined as an actionable lesion seen during a blinded review of the prior mammogram that was in the same quadrant as the cancer on the index mammogram. RESULTS: Of 149 prior mammograms originally read as non‐malignant, 46% (N=68) had a potentially detectable lesion. In unadjusted analyses, potentially missed detection was greater among minority patients (54% vs. 39%, p=0.07), for patients with incomes below $30,000 (65% vs. 36%, p<0.01), with less education (58% vs. 39%, p=0.02), and lacking private health insurance (63% vs. 40%, p=0.02). Likelihood ratio tests for the inclusion of socioeconomic variables in multivariable logistic regression models were highly significant (p<=0.02). CONCLUSIONS: Disadvantaged socioeconomic status appears to be associated with potentially missed detection of breast cancer at mammography screening.