Gaps in breast cancer interception efforts at a tertiary cancer center: who are we serving?

Purpose High-risk breast cancer screening programs (HRSPs) provide personalized interventions that can decrease one’s risk of breast cancer (BC). However, HRSPs introduce inequitable access and utilization by disadvantaged groups. Here, we retrospectively reviewed patients referred to HRSPs to discern race and socioeconomic status differences between those who attended the program versus those who did not. Methods A retrospective analysis was performed on two cohorts presenting for mammography at Indiana academic health centers: 1) patients identified as at increased risk of BC and referred to a HRSP via lay navigators and 2) newly diagnosed BC patients. Individuals attending the HRSP were compared to high-risk patients who declined/did not respond to HRSP invitation, and to newly diagnosed BC individuals. Age, race, insurance status, and neighborhood socioeconomic status were compared between cohorts using Chi-square or Fisher’s exact tests. Results Between 6/2020 and 6/2022, 601 women met criteria for contact by HRSP navigators. Patients accepting appointments were predominately White and privately insured. Black patients more frequently decline appointments compared to White (40.1% v. 29.1%, p = 0.008), and represented a higher proportion of those not attending HRSPs compared to those who did (19.8% v. 10.8%, p = 0.004). Patients diagnosed with BC were more commonly Black (19.4% v. 10.8%, p = 0.003), not privately insured (75.6% v. 84.2%, p = 0.012), and had lower median household incomes (69,611 v.72,656, p = 0.04). Conclusions Significant racial disparities exist amongst patients seen at a tertiary care center’s HRSP. As BC screening/prevention becomes more personalized, efforts should be focused on equitable delivery to minimize inequitable BC outcomes.