||1R01CA266377-01 Interpret this number
||University Of Washington
||Racial and Socioeconomic Disparities in Breast Cancer Diagnostic Work Up and Outcomes
U.S. women of minority race/ethnicity, lower education, lower income, rural residence, and the underinsured
experience higher breast cancer disease burden and lower survival rates than women without these
characteristics, despite recent improvements in screening access and treatments. The majority of efforts to
mitigate these disparities have focused on screening mammography access, but women must navigate
multiple additional steps when cancer is suspected, including more imaging, biopsies, and specialist
consultations. Each year, >12 million U.S. women enter this diagnostic care continuum. Failure to receive
timely, quality evaluation leads to delayed diagnosis, more invasive procedures, advanced cancer stage at
diagnosis, and greater mortality. Compared to screening, surprisingly little is known about disparities during
this diagnostic period. It is estimated that up to 30% of women with abnormalities detected by mammography
fail to obtain appropriate or timely follow-up, and up to 50% of racial/ethnic minorities and socioeconomically
disadvantaged women experience such failures. A clearer understanding of disparities along the diagnostic
continuum is hindered by the decentralized nature of breast cancer screening and diagnosis in the U.S., with
disparities in care likely due to a complex combination of individual, residential, and healthcare delivery factors.
We propose to conduct the largest U.S. observational study of disparities in diagnostic breast imaging to date.
Specifically, we aim to 1) identify specific subpopulations of women with lower access to and use of key
diagnostic imaging technologies; 2) determine differences in diagnostic outcomes that can serve as quality of
care indicators based on race/ethnicity and socioeconomic status; and 3) identify differences in timeliness of
diagnostic evaluation among disparities populations. We will use multi-level statistical modeling and mediation
analyses to account for multifactorial interactions that likely influence inequitable diagnostic care. Our team, the
Breast Cancer Surveillance Consortium, consists of national experts in breast cancer epidemiology,
biostatistics, health services research, medicine, and radiology. The BCSC represents the largest longitudinal
breast cancer imaging data resource linked to long-term outcomes that is representative of the general U.S.
population by race/ethnicity. We systematically collect woman-, exam-, residential-, practice-, provider- and
tumor-level data across seven regional registries and more than 200 individual practices. With data collected
for 13 million breast imaging exams, 5.5 million of which were performed among traditional disparities
populations, our team is well-positioned to carry out the proposed analyses. Our study will help shift the breast
cancer disparities research paradigm from focusing on screening access to evaluating the entire diagnostic
episode. By identifying novel quality of care metrics and “early warning” indicators of disparities, our results will
inform both practice-level interventions aimed at closing local disparities gaps and national practice guidelines
and policies directed towards more equitable breast cancer diagnostic evaluation.