Breast cancer remains one of the leading health concerns affecting millions of women worldwide. Early detection through effective screening programs is critical for improving survival rates and reducing the burden of this disease. Digital breast tomosynthesis (DBT), commonly known as 3D mammography, represents a significant advancement in breast cancer screening technology. Unlike traditional 2D digital mammography (DM), DBT provides more detailed images, enhancing the accuracy of cancer detection and reducing false-positive results, which can often lead to unnecessary stress and invasive procedures. However, financial barriers, even seemingly modest ones, can limit access to such lifesaving technology. A recent study published in the Journal of the American College of Radiology sheds light on this issue and offers promising insights into overcoming these barriers.
Scientific and Clinical Evidence: What the Data Tell Us
The study conducted by researchers at UCLA Health investigated the impact of removing a $45 out-of-pocket fee for DBT on its utilization compared to DM. This retrospective analysis included 13,284 patients who underwent screening mammograms between March 1, 2018, and August 31, 2022. By comparing data before and after the fee elimination in January 2021, researchers uncovered compelling evidence of increased DBT adoption.
Prior to the fee removal, DBT utilization stood at 83.7%, which rose to 91.5% post-intervention. The trends were particularly notable among minority groups and non-English-speaking patients. For example, DBT usage among Black and Hispanic patients increased by over 6%, and non-English-speaking patients experienced a 7.1% rise. These findings highlight how financial barriers disproportionately impact underserved populations, exacerbating existing health disparities.
Understanding Misconceptions and Barriers
Despite its clinical advantages, DBT is not universally adopted, partly due to misconceptions about its cost-effectiveness and accessibility. Some patients and healthcare providers may perceive the technology as prohibitively expensive or unnecessary for routine screening. Additionally, even modest out-of-pocket expenses can deter individuals from opting for advanced screening methods, particularly those from lower socioeconomic backgrounds or with limited access to insurance coverage.
Correct Health Practices and Practical Recommendations
The study underscores the importance of policy-level interventions to enhance access to advanced medical technologies. Health systems and policymakers should consider eliminating financial barriers to essential diagnostic procedures like DBT. Beyond fee removal, efforts such as patient education campaigns and culturally sensitive outreach programs can play a crucial role in ensuring equitable access.
For patients, understanding the benefits of DBT is vital. Women should actively discuss their screening options with healthcare providers, ensuring informed decisions based on their individual health profiles and risk factors. Providers, on the other hand, should advocate for accessible screening technologies and support initiatives that address systemic inequities in healthcare.
Expert Insights and Commentary
Dr. Nina M. Capiro, the lead author of the study and a diagnostic radiologist at UCLA Health, emphasized the significance of the findings: “These results demonstrate that even modest out-of-pocket costs can create meaningful barriers to accessing advanced screening technology. Eliminating these fees can improve health equity and allow more patients to benefit from lifesaving advancements like DBT.”
The research also highlights the nuanced challenges of achieving healthcare equity. While removing financial barriers is a critical step, other factors such as language barriers, geographic accessibility, and cultural perceptions of healthcare must also be addressed to create a truly inclusive system.
Conclusion
The study provides robust evidence that policy changes, like eliminating out-of-pocket fees, can significantly enhance access to advanced breast cancer screening technologies, particularly among underserved populations. While this represents a substantial stride toward health equity, it also underscores the need for multifaceted approaches to tackle persistent disparities. By prioritizing accessibility and inclusivity, healthcare systems can ensure that innovations like DBT benefit all, regardless of socioeconomic status.
References
1. Removing out-of-pocket fee improves access to 3D mammography. University of California Los Angeles Health Sciences. June 27, 2025. Accessed July 2, 2025. https://www.eurekalert.org/news-releases/1089133.
2. Capiro N, Khadka P, Sayre J, Sadigh G, Hoyt A. Effect of fee removal on the usage of digital breast tomosynthesis to minimize healthcare disparities. Journal of the American College of Radiology. 2025. doi:10.1016/j.jacr.2025.06.022 IF: 5.1 Q1 .
