Abstract C111: Do electronic health records assist providers to provide equitable referral for breast and cervical cancer screening between black and white women?
Authors: Ford Sabrina , Houdeshell-Putt Laura , Polverento Molly , Brooks Kevin 
Published: December 2023

Background: Breast and Cervical Cancer screening (BCS and CCS) are essential tools to prevent cancer. Yet, non-Hispanic Black (NHB) women die at a much higher rate from Breast and Cervical cancer than non-Hispanic White (NHW) women. Thus, it is important that providers recommend BCS (Mammogram) and CCS (Pap test), equitably, for maximum cancer prevention. Meaningful Use (MU), as part of the HITECH Act, incentivized providers to utilize electronic health records (EHR) not only for billing, but to increase the quality of patient care. MU also included an aim to reduce health disparities using EHR. The intent of this study was to evaluate BCS and CCS rates before and after the advent of MU to examine potential cancer screening disparities between NHW and NHB. It is imperative that cancer screenings are recommended, equally, to address grave disparities for NHB cancer mortality. Methods: Using a pre-post design, we examined  BCS and CCS rates before the enactment of MU (2013) in a Medicaid population and after MU implementation for years 2014-2016. Medicaid data were extracted from the Michigan Department of Health & Human Services data warehouse for Medicaid enrollees. Inclusion criteria were physicians who were continually enrolled in MU from 2014-2016 who saw women of BCS and CCS screening age. Odds Ratios were used to examine differences in screening rates over time between Black and White women. Results: For BCS, no differences were detected between NHW and NHB women, although a trend was observed for post-MU for 2015 (OR = 1.167, 95% CI [0.876, 1.580]). Analyses of CCS rates post-MU showed differences (p&lt;0.01) between NHW and NHB for 2014 (OR = 1.211, 95% CI [1.079, 1.377] and 2015 (OR = 1.141, 95% CI [1.029, 1.266], respectively. Regression analyses from 2013 to 2016 showed differences between NHW and NHB women for both BCS and CCS over time with NHW and NHB screening rates converging in 2016 (p&lt;0.05). Conclusion: We did not find any discernable differences in BCS between NHW and NHB women after providers subscribed to MU. CCS screening rates for NHB were higher than NHW in 2014-2015, but not in 2016. However, changes in BCS and CCS rates were significant by year and over time. For both BCS and CCS, rates converged over time for both NHW and NHB reducing screening disparities, but screening rates decreased over time. This decrease over time was attributable to changes in screening recommendations for both BCS and CCS (ACOG, ACS, CDC). Notably, the guidelines changed from yearly CCS to every three years for women at low-risk for cervical cancer. Further analyses are warranted to adjust for the change in screening guidelines. These findings are complex and will be fully discussed to discern screening differences between NHW and NHB women, and use of EHR as a tool to reduce health disparities.

Citation Format: Sabrina Ford, Laura Houdeshell-Putt, Molly Polverento, Kevin Brooks. Do electronic health records assist providers to provide equitable referral for breast and cervical cancer screening between black and white women? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C111.