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Grant Details

Grant Number: 5R01CA266377-03 Interpret this number
Primary Investigator: Lee, Christoph
Organization: University Of Washington
Project Title: Racial and Socioeconomic Disparities in Breast Cancer Diagnostic Work Up and Outcomes
Fiscal Year: 2023


Abstract

Project Summary 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.



Publications

Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort.
Authors: Miglioretti D.L. , Abraham L. , Sprague B.L. , Lee C.I. , Bissell M.C.S. , Ho T.H. , Bowles E.J.A. , Henderson L.M. , Hubbard R.A. , Tosteson A.N.A. , et al. .
Source: Annals Of Internal Medicine, 2024-09-03 00:00:00.0; , .
EPub date: 2024-09-03 00:00:00.0.
PMID: 39222505
Related Citations

Toward More Equitable Breast Cancer Outcomes.
Authors: Elmore J.G. , Lee C.I. .
Source: Jama, 2024-04-30 00:00:00.0; , .
EPub date: 2024-04-30 00:00:00.0.
PMID: 38687474
Related Citations

Using Machine Learning to Predict Adherence to Recommended Imaging Follow-Up.
Authors: Lawson M.B. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2024-03-08 00:00:00.0; , .
EPub date: 2024-03-08 00:00:00.0.
PMID: 38461916
Related Citations

Population Attributable Risk of Advanced-Stage Breast Cancer by Race and Ethnicity.
Authors: Kerlikowske K. , Chen S. , Bissell M.C.S. , Lee C.I. , Tice J.A. , Sprague B.L. , Miglioretti D.L. .
Source: Jama Oncology, 2024-02-01 00:00:00.0; 10(2), p. 167-175.
PMID: 38060241
Related Citations

Racial and ethnic variation in diagnostic mammography performance among women reporting a breast lump.
Authors: Nyante S.J. , Abraham L. , Aiello Bowles E.J. , Lee C.I. , Kerlikowske K. , Miglioretti D.L. , Sprague B.L. , Henderson L.M. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2023-07-13 00:00:00.0; , .
EPub date: 2023-07-13 00:00:00.0.
PMID: 37440458
Related Citations

Risk of cancer versus risk of cancer diagnosis? Accounting for diagnostic bias in predictions of breast cancer risk by race and ethnicity.
Authors: Gard C.C. , Lange J. , Miglioretti D.L. , O'Meara E.S. , Lee C.I. , Etzioni R. .
Source: Journal Of Medical Screening, 2023-06-12 00:00:00.0; , p. 9691413231180028.
EPub date: 2023-06-12 00:00:00.0.
PMID: 37306245
Related Citations

Addressing Racial Inequities in Access to State-of-the-Art Breast Imaging.
Authors: Lee C.I. , Lawson M.B. .
Source: Radiology, 2023 Feb; 306(2), p. e222405.
EPub date: 2022-10-11 00:00:00.0.
PMID: 36219120
Related Citations

Improving Health Equity in Adherence to Diagnostic Breast Imaging Workup Recommendations.
Authors: Lopez E.J. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2022 Dec; 19(12), p. 1310-1311.
EPub date: 2022-10-05 00:00:00.0.
PMID: 36208840
Related Citations

Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity.
Authors: Lawson M.B. , Bissell M.C.S. , Miglioretti D.L. , Eavey J. , Chapman C.H. , Mandelblatt J.S. , Onega T. , Henderson L.M. , Rauscher G.H. , Kerlikowske K. , et al. .
Source: Jama Oncology, 2022-08-01 00:00:00.0; 8(8), p. 1115-1126.
PMID: 35737381
Related Citations

Diagnostic Mammography Performance across Racial and Ethnic Groups in a National Network of Community-Based Breast Imaging Facilities.
Authors: Nyante S.J. , Abraham L. , Aiello Bowles E.J. , Lee C.I. , Kerlikowske K. , Miglioretti D.L. , Sprague B.L. , Henderson L.M. , Breast Cancer Surveillance Consortium .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2022-07-01 00:00:00.0; 31(7), p. 1324-1333.
PMID: 35712862
Related Citations

Tackling Health Disparities in Radiology: A Practical Conceptual Framework.
Authors: Lawson M.B. , Scheel J.R. , Onega T. , Carlos R.C. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2022 02; 19(2 Pt B), p. 344-347.
PMID: 35152959
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