Disparities in breast cancer prevention initiatives at a comprehensive cancer center: Who are we serving?
Authors: Phipps Savannah , Lokender Manjari , Konstantinopoulos Kali , Johnson Bailey , Ambro Jane , Althouse Sandra K. , Ballinger Tarah Jean 
Published: May 2024

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Background: Despite advances in personalized breast cancer risk assessment and screening, populations at highest risk for cancer-related mortality are often excluded. At the IU Simon Comprehensive Cancer Center, a high-risk screening program (HRSP) identifies and serves women at increased risk of breast cancer. Risk assessment using Tyrer Cuzick v.8 and Gail models is performed in mammography; women at increased risk are navigated to a clinic appointment to discuss individualized screening and prevention services including MRI, chemoprevention, and/or genetic testing. We hypothesize gaps in the demographic and socioeconomic (SES) characteristics of women seen for a HRSP appointment, compared to women receiving a cancer diagnosis at the same mammography sites. Methods: Retrospective review was performed of women who met criteria for the HRSP (age ≤65 and Gail 5 yr risk ≥3% or TC v.8 10-yr risk ≥8%, or recommended by the radiologist) and subsequently accepted, scheduled, and attended an appointment from 6/2020 to 6/2022 (n=233). This population was compared to women who were diagnosed with breast cancer at the same clinical sites over the same dates, without history of being evaluated in the HRSP. Age was restricted to ≤65 to match the HRSP population (n=685). Zip codes were used to calculate area-based SES by median household income and percent poverty. CDC social vulnerability index (SVI) was evaluated using the U.S. Census Bureau and American Community Survey (0=least vulnerable, 1=most vulnerable). Comparisons across groups by age, race, insurance status, area SES and SVI were made using the Wilcoxon or Chi-square test. Results: Cancer cases were significantly older than those attending the HRSP (median age 54 vs 49 p < 0.001). Black patients represented 19.4% of participants diagnosed with cancer, versus 10.8% of participants attending the HRSP (p=0.0032). There was also a disparity in insurance coverage, with 83.8% of women seen in the HRSP being privately insured, versus 75.6% of women diagnosed with cancer (p=0.011). There was no statistical difference in SVI (0.64 vs 0.66 p=0.11) or area poverty rate (11.2 vs 12.0 p=0.26) between the groups; cancer cases came from areas with lower household income (69,611 vs 73,165 p=0.04). Conclusions: Women seen in the HRSP were more likely to be younger, White, privately insured, and from an area with higher household income, compared to women diagnosed with cancer in the same health system at the same mammography sites. This highlights disparities in access to individualized breast cancer interception such as chemoprevention, high-risk screening, and genetic testing, which may further existing disparities in breast cancer-related mortality based on race and SES. Further studies will investigate barriers and motivators to personalized breast cancer prevention in high-risk groups, and utilize community partnerships to develop equitable interventions.