Making mammography inclusive for patients with disabilities

Lene Andersen, MSW, has been living with rheumatoid arthritis and disability since childhood. Her personal experience with limited mobility and the challenges faced in accessing mammography screening in Toronto, Ontario, has fueled her determination to advocate for change. Her story opens in new tab/window is featured in an upcoming themed issue of the Journal of Medical Imaging and Radiation Sciences opens in new tab/window on the topic of specialized populations, published by Elsevier.

In this personal narrative,Lene, an advocate and accessibility consultant, teamed up with Natasha Batchelor, MHSc, MRT(R), a medical imaging technologist from the York region in Ontario with expertise in creating an accessible mammography environment. Together, they have published a call to action for a national response to remove barriers in breast cancer screening. Blending personal and professional knowledge, they offer valuable insights into creating an inclusive environment and practice.

In this narrative, Lene outlines her experience as a wheelchair user with limited mobility in her arms and shoulders, which has created significant challenges in accessing mammography screenings. Despite having a lump in her breast for several decades, she was unable to undergo mammograms due to the lack of accessible equipment and procedures. She also highlights the challenges encountered as a wheelchair user with limited mobility, from contorting her body into uncomfortable positions for ultrasounds to the absence of fragrance-free gel triggering severe asthma attacks.

Reflecting on her journey, Lene emphasized, "Discovering that I was not considered or deliberately excluded from the breast cancer prevention system was a shock that still reverberates in my life. It woke me up to the many ways in which healthcare fails to meet the needs and protect the lives of disabled patients."

She further noted that “…lacking recent studies, documentation, and accessibility guides, mammography clinics are left without guidance and standards to remove barriers and make this essential screening test inclusive for people of all abilities. This results in a patchwork approach to accessibility, one that relies on the awareness of each clinic and its staff to identify a lack of equity, as well as a guesswork approach to accessibility with a resulting potential for inadequate resolution and barrier removal. It is reasonable to expect that this has a direct impact on early detection and survival rates in disabled patients.”

Natasha Batchelor, a mammography and breast imaging navigator/supervisor, has dedicated her career to improving the imaging experience for patients with disabilities. She has firsthand knowledge of the challenges faced by these individuals and has developed strategies and resources to address their unique needs. Natasha's commitment to creating an inclusive environment for patients with disabilities has led to the creation of a webinar and resource materials, providing valuable training for fellow technologists and healthcare professionals.

Together, the authors outline a three-pronged approach to tackle physical, social, and procedural barriers. The article outlines numerous common physical barriers such as standing-person only check-in counters, small mammography rooms with no room for mobility aids, or forms requiring handwriting. Essential considerations to remove physical barriers include accessibility features such as adjustable equipment, accessible changerooms, and fragrance-free policies. To address social barriers, such as bias, attitudes, and behaviors of health professionals, they stress the need for comprehensive training and resources. Procedural barriers refer to intake/admissions procedures and appointment accommodations, and the authors outline recommendations to improve these processes. By implementing the measures proposed in this call to action, healthcare systems can ensure that patients with disabilities have equal access to essential breast cancer screening services.

The authors underscore the need for meaningful consultations with disabled individuals (“nothing about us without us”) and the involvement of accessibility professionals in the analysis of existing barriers and the development of solutions. While recognizing the financial constraints faced by some areas, they urge professional associations and clinics to unite in advocating for funding to remove structural barriers. Simultaneously, they emphasize that immediate actions, such as awareness campaigns, accessibility training, and equipment adjustments, can be taken by clinics and technologists to improve accessibility and accommodate disabled patients.

Creating an inclusive environment for patients with disabilities requires collaboration among governments, healthcare systems, imaging associations, and individual clinics. The authors stress the importance of an equity-based and patient-centered approach to healthcare, urging stakeholders to prioritize the needs and experiences of disabled individuals. By addressing the identified barriers and implementing the recommended considerations, health systems can work towards eliminating inequities in breast cancer screening and ensure health equity for people with disabilities.

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Notes for editors

The article is “Making Mammography Inclusive for Patients with Disabilities,” by Lene Andersen, MSW, and Natasha Batchelor, MHSc, MRT(R) (https://doi.org/10.1016/j.jmir.2023.08.003 opens in new tab/window).It appears online in advance of the Journal of Medical Imaging and Radiation Sciences, volume 54, issue 4S (December 2023), published by Elsevier.

This article is openly available for 30 days at https://www.jmirs.org/article/S1939-8654(23)01818-0/fulltext opens in new tab/window.

Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 238 or [email protected] opens in new tab/window. Lene Andersen may be reached for comment at [email protected] opens in new tab/window.

An accompanying podcast is posted at https://podcasters.spotify.com/pod/show/jmirs opens in new tab/window. Excerpts from the podcast may be reproduced by the media; contact Eileen Leahy to obtain permission.

About the authors

Lene Andersen, MSW, is an author, advocate, accessibility consultant, and photographer based in Toronto, Canada. She utilizes her lived experience and professional expertise to champion accessibility and inclusion for individuals living with chronic illness and disability. Lene is the author of the award-winning blog, The Seated View opens in new tab/window, and several books on living well with chronic illness.

Natasha Batchelor, MHSc, MRT(R), is a mammography and breast imaging navigator/supervisor with over 10 years of experience. She has been actively involved in the disability community and has dedicated her career to providing accessible mammography services. Natasha has conducted research on breast cancer in people with intellectual disabilities and has created educational resources for imaging patients with disabilities.

About the Journal of Medical Imaging and Radiation Sciences (JMIRS)

The Journal of Medical Imaging and Radiation Sciences opens in new tab/window (JMIRS) is the official bilingual, peer-reviewed journal of the Canadian Association of Medical Radiation Technologists (CAMRT) opens in new tab/window. We aim to influence practice within the rapidly evolving fields of radiological, nuclear medicine, MRI, and ultrasound technologists and radiation therapists, grounded in our circular tagline “research informing practice – informing research.” JMIRS provides an essential platform for Canadian and international medical radiation technologists and therapists to publish and discover their own body of knowledge to define and inform their practice, enabling translation to a global audience. Published by Elsevier, JMIRS is included in MEDLINE and CINAHL. www.jmirs.org opens in new tab/window

About the Canadian Association of Medical Radiation Technologists (CAMRT)

The Canadian Association of Medical Radiation Technologists opens in new tab/window (CAMRT) is the national professional association and certifying body for radiological, nuclear medicine and magnetic resonance imaging technologists and radiation therapists. Recognized at home and internationally as a leading advocate for the profession of medical radiation technology, the CAMRT is an authoritative voice on the critical issues that affect its members and their practice. Established in 1942, the CAMRT today represents over 11,000 members. www.camrt.ca opens in new tab/window

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundation opens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

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