Disparities In Breast Cancer Care Research Articles

Racial disparities in breast cancer care among reproductive-aged women continued after COVID-19 pandemic.

e13757 Background: Despite the aggressive nature of breast cancer (BC) among women under 45 years old, racial disparities in BC care still exist. The COVID-19 pandemic highlighted racial disparities in care management. This study described staging, treatment use, and healthcare resource use (BC-HCRU) among reproductive-aged White, Asian, and Black women before and after COVID-19 to identify possible care changes. Methods: This retrospective claims study assessed White, Asian, and Black women aged 18 to 44 years old with newly diagnosed BC in the Komodo Research Dataset from August 2018-May 2023. Women were stratified based on their first observable BC diagnosis (index) into two cohorts, pre-COVID-19 (pre) (February-July 2019) and post-COVID-19 (post) (July-November 2022). Patients were required to have >6 months of medical and pharmacy continuous enrollment before (baseline) and after index (follow-up), and a second BC diagnosis during follow-up. BC-HCRU was defined as a claim with a BC diagnosis. Results: Pre-COVID-19 included 875 White, 116 Asian, and 267 Black women (mean age 39.0 years, 38.5 years and 37.8 years respectively) and post-COVID-19 included 879 White, 127 Asian, 386 Black women (mean age 38.8 years, 38.9 years and 37.9 years respectively). While the proportions with commercial insurance decreased (pre: White, Asian, Black: 72.5%, 71.6%, 42.7%; post: 51.9%, 61.4%, 23.6%) and with Medicaid increased (pre: White, Asian, Black: 24.3%, 27.6%, 53.6%; post: 45.2%, 38.6%, 75.1%) for all, most White and Asian women had commercial insurance and most Black women had Medicaid pre- and post-COVID-19. The proportion with metastatic BC increased for all in the post period, but lower incidences remained among White (pre: 20.7%; post: 25.1%) and Asian (pre: 17.2%; post: 22.8%) than Black women (pre: 25.5%; post: 28.0%). While both the proportions of White and Asian women with BC-related ER visits increased, suggesting greater acute care needs, the proportion of Asian women doubled and became higher than White women; the highest incidence also remained among Black women (pre: White, Asian, Black: 13.1%, 7.8%, 22.8%; post: 15.4%, 18.1%, 21.0%). The proportion with any treatment (medication, surgery, radiation) remained highest for Asian women (pre: 87.9%; post: 90.6%) and decreasingly lowest for Black women (pre: 84.3%; post: 80.3%), and the mean time to treatment remained shortest for White women (pre: 40.3 days; post: 44.3) and longest for Black women (pre: 47.4; post: 49.8). Conclusions: While COVID-19 affected BC care among all reproductive-aged women, racial disparities in BC care remained or increased in this vulnerable population. Comparative analyses assessing the factors driving these disparities should be explored to understand these health inequities further, and real-world clinical practice should consider these differences when implementing necessary BC management.

Geospatial disparities in breast cancer care in sub-Saharan Africa: time to act

Geospatial disparities in breast cancer care in sub-Saharan Africa: time to act

Abstract PO5-25-07: A research impact assessment method to evaluate Susan G. Komen’s research funding impact on drugs approved for breast cancer treatment

Abstract Susan G. Komen (Komen) is the largest private funder of breast cancer research, having invested nearly $1.1 billion in cutting edge breast cancer research with a focus on conquering deadly metastatic and aggressive breast cancers, advancing precision medicine, and addressing disparities in breast cancer care and outcomes. There is a growing demand on Komen and other research funders from patients, donors, and other constituents to understand how investments in biomedical research translate into clinical impact that is meaningful to patients, the public, and others beyond academic publications and other bibliometrics. Komen uses a variety of approaches to evaluate the impact of our research investments, including a recently developed method to determine how Komen’s funding has impacted discovery and development of breast cancer drugs approved by the FDA from 2012-2022. Utilizing bibliometric analysis derived from the Dimensions for Funders platform, we systematically identified links between Komen-funded research, Komen-funded researchers, and FDA approved drugs. First, we identified fundamental clinical trials that led to initial and expanded FDA approval of each drug from prescribing information labels and press releases. Using API technology, we then performed a bibliometric linkage analysis and analyzed citation results from fundamental clinical trial studies, working backwards to capture fundamental pre-clinical and basic research studies that identified each drug’s target and its functions in the context of breast cancer biology. After collecting and curating publications in an unbiased manner, we evaluated each published study and contributing authors for Komen support. We identified specific “touchpoints” for fundamental studies including direct Komen funding for the published study and/or Komen support of key personnel. Early results revealed direct and indirect Komen research touchpoints across the research pipeline for several drugs, including direct touchpoints for basic, pre-clinical, and clinical trial studies that led to FDA approval of the PI3K inhibitor alpelisib, basic research and pre-clinical studies that led to FDA approval of CDK4/6 inhibitors, and basic research studies that led to FDA approval of PARP inhibitors olaparib and talazoparib. By adopting this approach, we can demonstrate the impact of Komen’s research investment across the full development timeline for each drug. This will allow us to measure and communicate how Komen’s investment in innovative research from discovery to clinical development is driving advances in breast cancer clinical care that improves outcomes. Citation Format: Dana Brantley-Sieders, Lauren Leslie, Amy Dworkin, Kimberly Sabelko, Kari Wojtanik. A research impact assessment method to evaluate Susan G. Komen’s research funding impact on drugs approved for breast cancer treatment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-25-07.

The Impact of COVID-19 on Breast Cancer Care: A Qualitative Analysis of Surgeons’ Perspectives

IntroductionWhile studies have documented delays in breast cancer (BC) care during the COVID-19 pandemic due to healthcare restrictions, there have been no studies on the experiences, and, particularly, the challenges with providing care faced by breast surgeons during this unprecedented time. This paper aims to understand the perspectives of breast surgeons regarding the impact of the COVID-19 pandemic on BC care. MethodsWe used purposeful and snowball sampling to identify breast surgeons in Ontario, Canada. One-on-one qualitative semi-structured interviews were conducted exploring the impact of the pandemic on BC treatment, psychosocial well-being of patients and providers, and the future state of BC care. Audio-recorded interviews were transcribed verbatim and analyzed using Thematic Analysis. ResultsA total of 10 breast surgeons (5 community and 5 academic) were interviewed. Breast surgeons reported that the pandemic led to increased multidisciplinary collaboration and innovations in delivery of BC surgery (e.g., increased use of regional anesthesia). Multiple surgeons identified that the pandemic created disparities in BC care based geographic location and that existing disparities in care based on ethnicity or marginalization were exacerbated. Last, surgeons identified that virtual care improved, but also created some challenges to how BC care was delivered, with many hoping for this to be continued after the pandemic was over. ConclusionsIn this study, breast surgeons identified unique challenges and solutions to BC care delivery during the pandemic. Concerns regarding disparities in care based on geographic location and marginalized patients require further study to improve future BC care.

Guideline-concordant breast cancer care by patient race and ethnicity accounting for individual-, facility- and area-level characteristics: a SEER-Medicare study.

To examine racial-ethnic variation in adherence to established quality metrics (NCCN guidelines and ASCO quality metrics) for breast cancer, accounting for individual-, facility-, and area-level factors. Data from women diagnosed with invasive breast cancer at 66+ years of age from 2000 to 2017 were examined using SEER-Medicare. Associations between race and ethnicity and guideline-concordant diagnostics, locoregional treatment, systemic therapy, documented stage, and oncologist encounters were estimated using multilevel logistic regression models to account for clustering within facilities or counties. Black and American Indian/Alaska Native (AIAN) women had consistently lower odds of guideline-recommended care than non-Hispanic White (NHW) women (Diagnostic workup: ORBlack 0.83 (0.79-0.88), ORAIAN 0.66 (0.54-0.81); known stage: ORBlack 0.87 (0.80-0.94), ORAIAN 0.63 (0.47-0.85); seeing an oncologist: ORBlack 0.75 (0.71-0.79), ORAIAN 0.60 (0.47-0.72); locoregional treatment: ORBlack 0.80 (0.76-0.84), ORAIAN 0.84 (0.68-1.02); systemic therapies: ORBlack 0.90 (0.83-0.98), ORAIAN 0.66 (0.48-0.91)). Commission on Cancer accreditation and facility volume were significantly associated with higher odds of guideline-concordant diagnostics, stage, oncologist visits, and systemic therapy. Black residential segregation was associated with significantly lower odds of guideline-concordant locoregional treatment and systemic therapy. Rurality and area SES were associated with significantly lower odds of guideline-concordant diagnostics and oncologist visits. This is the first study to examine guideline-concordance across the continuum of breast cancer care from diagnosis to treatment initiation. Disparities were present from the diagnostic phase and persisted throughout the clinical course. Facility and area characteristics may facilitate or pose barriers to guideline-adherent treatment and warrant future investigation as mediators of racial-ethnic disparities in breast cancer care.

Abstract 1293: Uncovered: The breast cancer journey of a Black woman from advocacy to awareness to action

Abstract Background: There have been 3 significant life events guiding my journey from being a young, Black mother with stage 4 breast cancer and thyroid cancer to an engaged patient partner. The first was having a benign breast tumor removed at age 14. The second was my 2017 mBC diagnosis, including my bilateral mastectomy and the lack of images and information available for Black women concerning reconstruction and scar management. The third is exclusion from and the lack of diversity in clinical trials. Objective: In order to address the disparities in cancer and my unmet needs, I use my story and experiences as a catalyst for change primarily in three forms, which have evolved over time: advocacy, awareness, and action. Methods: Advocacy: To unburden myself from the shame about my breast health and the scar from my surgery at age 14, I vocalized my concerns and needs as an adult navigating my breast reconstruction options after my 2017 cancer diagnosis. Ongoing frustration that my needs were not being addressed led me to create Uncovered: A Breast Recognition Project, in collaboration with Rethink Breast Cancer. Uncovered, a digital and print resource, shines a light on the disparities and challenges that Black, Indigenous and people of color face in breast cancer care. Awareness: The 2020 edition started with my story and those of 7 Black women. After Uncovered launched, other racialized women reached out with similar experiences. The resource was expanded in 2021 to include stories and images of an Inuk woman, Black women, and women of color. This confirmed a systemic need to raise awareness and address racialized communities and inequities in breast cancer care. Action: As a result of the slow progress towards systemic change, I, along with the women of Uncovered, co-created the Wish List in 2021. The Uncovered Wish List is 6 accessible and actionable items that should be a priority for ending disparities in breast cancer care. Due to the complexity of my diagnosis, which limits my clinical trial options, and the historical underrepresentation of racialized communities in clinical trials, I now partner with cancer institutions and organizations that focus on research to address ongoing unmet needs with the goal to improve equity, diversity and inclusion. Results: Uncovered is a first-of-its-kind resource in Canada. To date, it has had a global reach of over 70 million through conferences, panels, podcasts, resource links, presentations, and various media. The recognition of my story, Uncovered, and the Wish List allows me to form collaborative connections, and become an engaged patient partner committed to systemic change. Conclusion: Despite systemic barriers, it is possible for Black women with breast cancer to advocate, raise awareness and take action towards change in meaningful ways. Citation Format: Michelle Audoin. Uncovered: The breast cancer journey of a Black woman from advocacy to awareness to action [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1293.

Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity.

Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.

The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches.

The South African Breast Cancer and HIV Outcomes prospective cohort (SABCHO) study was established to investigate survival determinants among HIV-positive and HIV-negative SA women with breast cancer. This paper describes common and unique characteristics of the cancer centres and their participants, examining disparities in pathways to diagnosis, treatment resources and approaches adopted to mitigate resource constraints. The Johannesburg (Jhb), Soweto (Sow), and Durban (Dbn) sites treat mainly urban, relatively better educated and more socioeconomically advantaged patients whereas the Pietermaritzburg (Pmb) and Empangeni (Emp) sites treat predominantly rural, less educated and more impoverished communities The Sow, Jhb, and Emp sites had relatively younger patients (mean ages 54 ±14.5, 55±13.7 and 54±14.3 respectively), whereas patients at the Dbn and Pmb sites, with greater representation of Asian Indian women, were relatively older (mean age 57 ±13.9 and 58 ±14.6 respectively). HIV prevalence among the cohort was high, ranging from 15%-42%, (Cohort obesity (BMI ≥ 30 kg/m2) at 60%, self-reported hypertension (41%) and diabetes (13%). Direct referral of patients from primary care clinics to cancer centre occurred only at the Sow site which uniquely ran an open clinic and where early stage (I and II) proportions were highest at 48.5%. The other sites relied on indirect patient referral from regional hospitals where significant delays in diagnostics occurred and early-stage proportions were a low (15%- 37.3%). The Emp site referred patients for all treatments to the Dbn site located 200km away; the Sow site provided surgery and endocrine treatment services but referred patients to the Jhb site 30 Km away for chemo- and radiation therapy. The Jhb, Dbn and Pmb sites all provided complete oncology treatment services. All treatment centres followed international guidelines for their treatment approaches. Findings may inform policy interventions to address national and regional disparities in breast cancer care.

A REVIEW OF CHALLENGES AND PROSPECTS OF MOBILE MAMMOGRAPHY SCREENING IN DEVELOPING COUNTRIES

Abstract Breast cancer is the most common cancer among women worldwide, accounting for approximately 25% of all female cancer cases. Given the increasing impact of breast cancer in developing countries, early detection and timely treatment are crucial in reducing morbidity and mortality associated with the disease. Mammography screening is a well-established method for early detection, as it can identify breast cancer at an early stage when the chances of successful treatment are higher. Mobile mammography screening has the potential to significantly improve early detection and reduce mortality rates associated with breast cancer in developing countries. However, various challenges still impede the full realization of its benefits. This review article aims to identify and explore the challenges and prospects of implementing mobile mammography screening programs in developing countries, and to provide recommendations on how to overcome these obstacles. Overall, the future of mobile mammography screening in developing countries can be promising, with opportunities for technological advancements, increased global cooperation, and ongoing research to further enhance the effectiveness of these programs. By seizing these opportunities and addressing the challenges related to accessibility, affordability, human resources, cultural and social factors, and infrastructure, mobile mammography screening can make a significant impact on the lives of women in developing countries and contribute to reducing global disparities in breast cancer care. Several successful mobile mammography screening projects in low- and middle-income countries showcase the potential for such programs to improve access to early detection services, raise breast cancer awareness, and ultimately reduce breast cancer mortality rates. By adapting best practices and lessons learned from these projects, other low- and middle-income countries can develop and implement mobile mammography screening programs tailored to their unique contexts and resource constraints.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020.

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Understanding Improvements in Disparities in Breast Cancer Care in Memphis, Tennessee: A Comparison of Two Time Cohorts

By Linnea Cripe, Ambria Moten & 2 more. A study that assesses current breast cancer outcomes for Black women in Memphis and identifies opportunities for continued investment in the community and hospital system.

Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer.

BackgroundDespite improvements, disparities in breast cancer care have led to an inequitable distribution of treatment delays and worse outcomes among patients with breast cancer. This study aimed to quantify the contribution of mediators that may explain racial/ethnic disparities in breast cancer treatment delays.Patients and MethodsWe conducted a retrospective analysis of patients from the National Cancer Database with stage I–III breast cancer who underwent surgical resection. Mediation analyses estimated the extent to which racial/ethnic disparities in the distribution of patient characteristics account for racial/ethnic disparities in delayed treatment.ResultsOf the 1,349,715 patients with breast cancer included, 10%, 5%, and 4% were Black, Hispanic, and other non-white race/ethnicity, respectively. Multivariable models showed that patients in these racial/ethnic groups had 73%, 81%, and 24% increased odds of having a treatment delay relative to white patients. Mediation analyses suggested that 15%, 19%, and 15% of the treatment delays among Black, Hispanic, and other non-white race/ethnicity patients, respectively, are explained by disparities in education, comorbidities, insurance, and facility type. Therefore, if these mediators had been distributed equally among all races/ethnicities, a reduction of 15–19% in the delayed treatment disparities experienced by minority patients would have been observed. Academic facility type was the factor that could yield the largest reduction in time to treatment disparities, contributing to 8–13% of racial/ethnic disparities.ConclusionsPatients with breast cancer who identified as Black, Hispanic, and other non-white races/ethnicities are exposed to longer treatment delays relative to white patients. Efforts to equalize mediators could remove substantial portions of racial/ethnic disparities in delayed treatment.

Racial Disparities in Time to Treatment Persist in the Setting of a Comprehensive Breast Center.

Racial disparities in breast cancer care have been linked to treatment delays. We explored whether receiving care at a comprehensive breast center could mitigate disparities in time to treatment. Retrospective chart review identified breast cancer patients who underwent surgery from 2012 to 2018 at a comprehensive breast center. Time-to-treatment intervals were compared among self-identified racial and ethnic groups by negative binomial regression models. Overall, 2094 women met the inclusion criteria: 1242 (59%) White, 262 (13%) Black, 302 (14%) Hispanic, 105 (5%) Asian, and 183 (9%) other race or ethnicity. Black and Hispanic patients more often had Medicaid insurance, higher American Society of Anesthesiologists (ASA) scores, advanced-stage breast cancer, mastectomy, and additional imaging after breast center presentation (p<0.05). After controlling for other variables, racial or ethnic minority groups had consistently longer intervals to treatment, with Black women experiencing the greatest disparity (incidence rate ratio 1.42). Time from initial comprehensive breast center visit to treatment was also significantly shorter in White patients versus non-White patients (p<0.0001). Black race, Medicaid insurance/being uninsured, older age, earlier stage, higher ASA score, undergoing mastectomy, having reconstruction, and requiring additional pretreatment work-up were associated with a longer time from initial visit at the comprehensive breast center to treatment on multivariable analysis (p<0.05). Racial or ethnic minority groups have significant delays in treatment even when receiving care at a comprehensive breast center. Influential factors include insurance delays and necessity of additional pretreatment work-up. Specific policies are needed to address system barriers in treatment access.

Patient Sociodemographic Characteristics Associated With Saturday Breast Imaging Clinic Utilization.

To determine patient sociodemographic characteristics associated with breast imaging utilization on Saturdays to inform potential initiatives designed to improve access and reduce disparities in breast cancer care. This was an IRB-approved retrospective cross-sectional study. All adult women (aged ≥18 years) who received a screening or diagnostic examination at our breast imaging facility from January 1, 2016 to December 31, 2017 were included. Patient characteristics including age, race, primary language, partnership status, insurance status, and primary care physician status were collected using the electronic medical record. Multiple variable logistic regression analyses were performed to evaluate patient characteristics associated with utilization. Of 53 695 patients who underwent a screening examination and 10 363 patients who underwent a diagnostic examination over our study period, 9.6% (5135/53 695) and 2.0% (209/10 363) of patients obtained their respective examination on a Saturday. In our multiple variable logistic regression analyses, racial/ethnic minorities (odds ratio [OR], 1.5; 95% confidence interval [CI]: 1.4-1.6; P < 0.01) and women who speak English as a second language (OR, 1.1; 95% CI: 1.0-1.3; P = 0.03) were more likely to obtain their screening mammogram on Saturday than their respective counterparts. Racial/ethnic minorities and women who speak English as a second language were more likely to obtain their screening mammogram on Saturdays than their respective counterparts. Initiatives to extend availability of breast imaging exams outside of standard business hours increases access for historically underserved groups, which can be used as a tool to reduce breast cancer-related disparities in care.

ASO Visual Abstract: The Role of Safety Net Hospitals in Reducing Disparities in Breast Cancer Care

ASO Visual Abstract: The Role of Safety Net Hospitals in Reducing Disparities in Breast Cancer Care

The Role of Safety-Net Hospitals in Reducing Disparities in Breast Cancer Care.

Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142-150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.

How Does Patient Socioeconomic Position Affect Breast Cancer Surgical Treatment and Mortality?: A Rapid Review.

BackgroundBreast cancer is the second leading cause of death in women across the world. Despite significant improvements in overall breast cancer survival, disparities still exist. Research shows that socioeconomic position (SEP) plays a strong role in disparities in breast cancer care. Lower SEP can be a predictor of poorer breast cancer health outcomes and treatment received. No recent review has focused on SEP and breast cancer surgery outcomes. We conducted a rapid review assessing how patient SEP affects breast cancer surgical outcomes.MethodsWe developed and ran the search strategy in Ovid MEDLINE in January 2021. We assessed study eligibility using an adapted version of PICOS criteria. We included observational studies that assessed the relationship between SEP and breast cancer surgery treatment, including outcomes like surgery choice, survival, and wait time to surgery. We independently reviewed each article and independently extracted data using a pre-designed form. One reviewer narratively synthesized the data extracted from the included articles.ResultsWe found twelve articles that met inclusion criteria. Eight out of 12 articles showed a difference in breast cancer surgery outcomes based on at least one measure of SEP. Six out of eight articles that collected surgery choice data found that women with lower SEP had lower rates of breast conserving surgery. One out of three articles that collected survival data found that higher SEP had a positive effect on survival. Additionally, one article that collected wait time to surgery data found a significant correlation between lower SEP and longer delays to surgical treatment.ConclusionIn conclusion, our rapid review of SEP and breast cancer surgery outcomes found that there is a relationship between SEP and breast cancer surgery choice. This rapid review did not find enough evidence to see a relationship with overall survival and wait time to surgery.

Satisfaction with care and attention to salient concerns by race in a diverse national sample of young women with breast cancer.

e18561 Background: Young women with breast cancer (BC) have unique issues, including fertility, genetic, and emotional health concerns; these may sometimes be inadequately addressed by providers. Given documented disparities in BC care and outcomes, we sought to explore whether provider attention to these issues differs by race, as well as to examine racial differences in satisfaction with care among young patients with BC. Methods: The Young &amp; Strong Study was a cluster randomized trial of an educational and supportive care intervention at 14 academic + 40 community oncology practices across the US enrolling women with newly diagnosed BC at age ≤45 and their providers. Patients completed surveys at baseline, 3, 6, and 12 months after enrollment. Race was self-reported at baseline. Provider attention to fertility, genetics, and emotional health was evaluated by medical record review. The proportions of patients with attention to these concerns by 3 months was compared by race (white, Black, Asian, multi-racial/other/unknown) using Fisher’s exact tests. Satisfaction with care was assessed with the Patient Satisfaction Questionnaire-18 (PSQ-18) at 3 months. Median scores for each of 7 PSQ-18 subscales (1-5 scale, higher scores=more satisfaction) were compared by race with the Kruskal-Wallis test. Results: 465/467 (99.6%) of enrolled patients had evaluable data. 77% were white, 12% Black, 4% Asian, and 7% multiracial/other/unk. Median age at diagnosis was 40 (range: 22-45) years. Provider attention to genetics (≥85%) and emotional health (≥90%) was high across groups, and there were no differences by race in attention to fertility, genetics, or emotional health (Table). Among 359/465 women (77%) who completed the PSQ-18, median subscale scores ranged from 3.5-4.5, indicating high levels of satisfaction with care. For the PSQ-18 technical quality domain, median scores were lower (p=.03), indicating less satisfaction, in Black and Asian women (4.0) and higher in white women (4.5). Median scores for other PSQ-18 domains (general satisfaction, interpersonal manner, communication, financial, time spent with doctor, accessibility) did not differ by race. Conclusions: Satisfaction with care was high and issues related to fertility, genetics and emotional health were addressed by providers in the majority of young women in our study, with minimal differences by race. These patients were all enrolled in a clinical trial and had access to high-quality care, limiting the generalizability of our findings. Larger, population-based studies in more diverse settings are warranted. Clinical trial information: NCT01647607. Attention to psychosocial concerns by race. [Table: see text]

Optimizing care of breast cancer patients from low resource countries who immigrate to New York City: A case series from a large public hospital.

Global disparities in breast cancer care become particularly evident when patients seek definitive care in the United States (USA) after receiving a breast cancer diagnosis and initiating care in low- and middle-income countries (LMICs). We performed a retrospective review of 26 patients with breast cancer who immigrated from LMICs and received care at Bellevue Hospital. Fifteen (58%) presented with advanced disease (stage III or IV), including 7 (27%). All 26 patients required diagnostic work-up in the USA, and all 19 (73.1%) patients with stage 0-III disease underwent surgical excision. Patients from LMICs frequently present with advanced disease and in varying stages of breast cancer treatment. Improving communication with previous providers and fostering a collaborative approach with the international community are essential to developing efficacious treatment plans and improving oncologic outcomes.

Abstract B055: Translating research into practice: Early lessons from a pragmatic clinical trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative

Abstract Racial and socioeconomic disparities in breast cancer mortality persist; in Boston, Black women and Medicaid patients are 2-3 times more likely to have delays in initiating cancer treatment compared to their white and privately insured counterparts. Evidence-based strategies for combating delays exist but are not systematically implemented. Our primary research question is: can systematically implement evidence-based coordination of care across the city of Boston to reduce delays for the most vulnerable women? Translating Research Into Practice (TRIP) addresses racial and socio-economic disparities using the principals of community engaged research. Four of the Massachusetts Clinical and Translational Science Institutes (CTSI) have collaborated with the Boston Breast Cancer Equity Coalition, the Boston Patient Navigation Network, and a Clinical Advisory Panel to systematically implement an evidence-based coordination of care intervention in six Boston hospitals. Key components of the intervention include: patient navigation, a shared regional registry to track women across institutions and facilitate navigator coordination, systematic screening for social barriers to care and referral to free or low-cost community resources. The multi-component implementation strategy includes ongoing stakeholder engagement, navigator performance review and feedback, training and support and navigator peer learning. A stepped-wedge hybrid type I (n=536 post implementation, n=564 historical controls) effectiveness-implementation study design was launched in June 2018, with 6 sites entering intervention phase by December 2019. Primary clinical outcomes are time to first treatment and receipt of guideline concordant care. Secondary implementation outcomes are acceptability, adoption, cost, fidelity, penetration, and sustainability. To date, we have 59 women on study in the intervention phase. We are reaching our target population: 39% of women are Black, 32% of Hispanic ethnicity, 47% are non-English speaking and 81% have Medicaid. Lessons learned with implementing a community-engaged, regional pragmatic trial include: 1) Patient Navigators are eager to collaborate in the care of their patients and to identify best practices; 2) Engaging all stakeholders, including hospital administrators, is necessary to implement health systems programs; 3) Workflow variation across each health system requires significant customization to adapt the evidence and tools; 4) Tension for change exists among all sites because of existing established care coordination programs; and 5) Lack of integration of EHRs within and across health systems makes use of new data platforms challenging. Regional, community-engaged, interdisciplinary collaborations are important to reduce population disparities than often transcend a single institution. TRIP outlines a coordinated model to address disparities in breast cancer care that could be translated to other regions and disease conditions. Citation Format: Amy LeClair, Stephenie Lemon, Jennifer Haas, Rachel Friedman, Howard Cabral, Karen Burns-White, Nicole Casanova, Karen Freund, Tracy Battaglia. Translating research into practice: Early lessons from a pragmatic clinical trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B055.