Appropriate Use of Medical Interpreters in the Breast Imaging Clinic.

More than 25 million Americans have limited English-language proficiency (LEP) according to the U.S. Census Bureau. This population experiences challenges accessing health care and is least likely to receive preventive health care, including screening mammogram. In a setting where the breast radiologist does not speak the language of their patient, using certified medical interpreter services is fundamental. Medical interpreter use is associated with improved clinical care and patient satisfaction and can potentially increase adherence to screening mammograms and follow-up in patients with LEP. Title VI of the Civil Rights Act requires interpreter services for patients with LEP who are receiving federal financial assistance. Failure to provide interpretative services when necessary is considered discriminatory and illegal. The use of untrained medical interpreters, including ad hoc interpreters (eg, family, friends, or untrained staff), is associated with more medical errors, violation of confidentiality, and poor health outcomes. Types of medical interpretation services available to address language barriers include in-person interpretation, telephone and video remote interpretation, and qualified bilingual staff. Proper training and certification of medical interpreters is essential to prevent misinterpretations and ensure patient safety. When using an interpreter service, speak to and maintain eye contact with the patient, address the patient directly and seat the interpreter next to or slightly behind the patient, use visual aids whenever possible, and have the patient repeat the information to verify comprehension. Breast radiologists can address disparities in breast cancer screening and treatment by promoting effective communication.

Culturally Competent Care in the Breast Imaging Clinic: Hispanic/Latino Patients.

Hispanic/Latino people represent 19% of the U.S. population, and this proportion is expected to increase to 26% by 2050. Hispanic/Latino people comprise a diverse ethnic group that includes individuals from all races, religions, languages, cultural identities, and nationalities. Barriers to health care that have created significant disparities in this community include language, low socioeconomic status, and inability to afford health insurance. Health coverage for Hispanic/Latino people has been a longstanding problem in the U.S., stopping many of these patients from seeking preventive care such as screening mammography. Breast cancer is the most common cancer among Hispanic/Latino women in the U.S. and the leading cause of cancer death in this group. Five-year breast cancer survival in Hispanic/Latino women is slightly lower than that in non-Hispanic White women. Some of the factors that account for the ethnic disparities in breast cancer include lower levels of adherence to screening mammography of Hispanic/Latino women as a consequence of inadequate insurance coverage, language barriers, lack of transportation, being unable to leave work, and lack of childcare. By promoting a culturally sensitive clinical environment, breast radiologists can increase patient engagement, utilization of preventive services, treatment adherence rates, and overall health status.

A Needs Assessment for Inclusion, Diversity, and Equity: Survey Results of the Society of Breast Imaging.

OBJECTIVE: To assess and understand the inclusion, diversity, and equity (IDE) needs of the Society of Breast Imaging (SBI) membership to guide development of a strategic plan and goals for the Inclusion, Diversity, Equity Alliance (IDEA) of SBI. METHODS: A 23-question survey developed by IDEA was distributed electronically to all SBI members in November 2020 to assess and understand the society's IDE needs. Descriptive statistics were used to summarize the responses. Open-ended responses were reviewed by the authors and sorted into three categories: supportive, nonsupportive, or neutral suggestions. RESULTS: The response rate was 12% (453/3686). Only 55% (238/429) of respondents agreed that the diversity of SBI leadership reflected the diversity of the society, with stronger agreement that actions of SBI aligned with their core values of collaboration and collegiality (327/249,75%), and of respect for diversity and inclusiveness (303/429, 70%). Overall, 65% (172/264) of respondents were satisfied with the quality and diversity of speakers at the annual symposium; however, White respondents agreed more compared to non-White respondents (P = 0.035), and those practicing greater than 20 years agreed more compared to those practicing 6 to 10 years (P = 0.023). Of 88 total suggestions, three common themes were: more resources for recruitment, retention, and education for a diverse staff; further increase in diversity among leadership and membership; and more patient care resources. CONCLUSION: In addition to showing areas of agreement by SBI members, this survey also identified opportunities for SBI and IDEA to further incorporate IDE into our initiatives and organization.

The Challenge of Digital Breast Tomosynthesis-Detected Architectural Distortion of the Breast: Inter-reader Variability and Imaging Characteristics That May Improve Positive Predictive Value.

OBJECTIVE: To compare readers' performances when detecting architectural distortion (AD) on digital breast tomosynthesis (DBT). To determine the risk of malignancy of DBT with synthetic mammogram (SM)-detected AD and evaluate imaging features that are associated with malignancy risk. METHODS: This IRB-approved retrospective review included all cases of DBT-detected AD that were recommended for biopsy from October 2013 to July 2019. Cases were reviewed by three breast radiologists and the overall agreement between radiologists was calculated. Medical records were reviewed for pathological outcomes and imaging findings. Statistical analyses used were Cohen's kappa and its 95% confidence interval, and one-way analysis of variance. RESULTS: A total of 172 lesions were included. The overall agreement for the presence of AD in our study was fair (0.253). The majority (20/36, 55.5%) of the malignant ADs were associated with asymmetries (13/36, 36.1%), calcifications (4/36, 11.1%), or both (3/36, 8.3%), compared to nonmalignant ADs (40/136, 31.0%; P = 0.038). The positive predictive value (PPV) of DBT with SM-detected AD for malignancy was 21.8% (36/165), 18.8% (18/96) for DBT-detected AD, and 26.0% (18/69) for SM-detected AD, although the difference was not statistically significant (P = 0.258). A breast MRI correlate was identified for all malignant AD lesions (17/17, 100.0%; P = 0.004). CONCLUSION: The detection of AD remains a challenging task for radiologists, with moderate-to-fair interobserver agreement. With a PPV for malignancy of 21.8%, percutaneous biopsy and subsequent pathology-imaging correlation are necessary for AD to exclude the possibility of malignancy.