Eliminating Fees for Digital Breast Tomosynthesis: Improved Utilization But Persistent Inequities

In a significant advancement for breast cancer screening, a recent study published on June 19, 2025, in the Journal of the American College of Radiology indicates that the removal of out-of-pocket costs for digital breast tomosynthesis (DBT) has led to an increase in utilization rates among diverse patient groups. However, despite this improvement, the study highlights that racial and socio-economic disparities in access to this technology persist.

The research, led by Dr. Nina Capiro, a radiologist at the University of California, Los Angeles (UCLA), analyzed screening mammograms conducted before and after the elimination of a $45 out-of-pocket fee for DBT at academic institutions and affiliated outpatient imaging centers. This fee was removed in January 2021 after most insurers began covering the procedure without requiring patient cost-sharing.

According to the study, the overall utilization of DBT increased from 83.7% to 91.5% following the removal of the fee. Notably, DBT usage among Hispanic patients rose by 6.2 percentage points, Black patients by 6.2 percentage points, and Asian patients by 5 percentage points relative to white patients. Furthermore, non-English-speaking patients experienced a 7.1 percentage point increase in utilization compared to their English-speaking counterparts.

Despite these gains, the study found that disparities remain. “Even following the removal of the fee for screening DBT, white patients, English-speaking patients, and those with Medicare continued to have the highest rates of DBT utilization,” Capiro and her team noted. This indicates that systemic factors such as physician referral patterns, health literacy, and lingering concerns about healthcare costs continue to influence access to breast cancer screening technologies.

The study underscores the importance of addressing these remaining barriers to achieve equitable breast cancer screening outcomes. It emphasizes that while the elimination of patient fees represents a positive step, more comprehensive strategies are needed to ensure all patient groups benefit equally from advancements in screening technology.

Dr. Capiro's findings echo broader concerns about health equity in the United States. According to the Centers for Disease Control and Prevention (CDC), disparities in breast cancer outcomes are often linked to factors such as socioeconomic status and access to care (CDC, 2021). This aligns with a report from the American Cancer Society, which highlights that Black women are more likely to die from breast cancer compared to their white counterparts, despite similar incidence rates (American Cancer Society, 2022).

In the context of these findings, the researchers advocate for future interventions that prioritize equity in breast cancer screening to reduce disparities and improve outcomes across all patient demographics. Addressing these issues not only benefits individual patients but also contributes to public health efforts aimed at reducing the overall burden of breast cancer in society.

As health systems continue to grapple with the complexities of equitable care, the findings from this study serve as a critical reminder of the ongoing work required to eliminate barriers to access and ensure that innovations in healthcare technology are available to all populations.

In conclusion, while the removal of out-of-pocket costs for DBT has led to increased utilization rates, the persistent inequities in access to breast cancer screening highlight the need for continued efforts to address the underlying factors that contribute to disparities in healthcare. Future policies and programs must focus on holistic approaches that consider the unique challenges faced by different patient groups to foster true equity in breast cancer outcomes.