Inequities in referrals to a breast cancer risk assessment and prevention clinic: a mixed methods study

BMC Primary Care

Research

Fisher Katlin¹  Claire B. King¹  Tari A. King²  Elizabeth A. Mittendorf²  Brittany L. Bychkovsky³  Lydia E. Pace⁴  Neil Maniar⁵  Danielle M. Crookes⁶  Rachel A. Freedman⁷  Anna Revette⁸  Erica T. Warner⁹ 

[1] Comprehensive Breast Health Center, Brigham and Women’s Hospital, Boston, MA, USA;Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA;Comprehensive Breast Health Center, Brigham and Women’s Hospital, Boston, MA, USA;Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA;Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Comprehensive Breast Health Center, Brigham and Women’s Hospital, Boston, MA, USA;Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA;Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA;Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Comprehensive Breast Health Center, Brigham and Women’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA;Department of Health Sciences, Northeastern University, Boston, MA, USA;Department of Health Sciences, Northeastern University, Boston, MA, USA;Department of Sociology and Anthropology, Northeastern University, Boston, MA, USA;Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA;Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Division of Population Science, Dana-Farber Cancer Institute, Boston, MA, USA;Harvard T.H. Chan School of Public Health, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Massachusetts General Hospital, Boston, MA, USA;

关键词: Health equity;    Breast cancer;    Referrals;    Screening;    Prevention;    Risk evaluation;   

DOI  :  10.1186/s12875-023-02126-1

 received in 2022-11-03, accepted in 2023-08-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInequitable access to personalized breast cancer screening and prevention may compound racial and ethnic disparities in outcomes. The Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) program, located within the Brigham and Women’s Hospital (BWH) Comprehensive Breast Health Center (BHC), provides care to patients at high risk for developing breast cancer. We sought to characterize the differences between BWH primary care patients referred specifically to B-PREP for risk evaluation and those referred to the BHC for benign breast conditions. Through interviews with primary care clinicians, we sought to explore contributors to potentially inequitable B-PREP referral patterns.MethodsWe used electronic health record data and the B-PREP clinical database to identify patients referred by primary care clinicians to the BHC or B-PREP between 2017 and 2020. We examined associations with likelihood of referral to B-PREP for risk assessment. Semi-structured interviews were conducted with nine primary care clinicians from six clinics to explore referral patterns.ResultsOf 1789 patients, 78.0% were referred for benign breast conditions, and 21.5% for risk assessment. In multivariable analyses, Black individuals were less likely to be referred for risk than for benign conditions (OR 0.38, 95% CI:0.23–0.63) as were those with Medicaid/Medicare (OR 0.72, 95% CI:0.53–0.98; OR 0.52, 95% CI:0.27–0.99) and those whose preferred language was not English (OR 0.26, 95% CI:0.12–0.57). Interviewed clinicians described inconsistent approaches to risk assessment and variable B-PREP awareness.ConclusionsIn this single-site evaluation, among individuals referred by primary care clinicians for specialized breast care, Black, publicly-insured patients, and those whose preferred language was not English were less likely to be referred for risk assessment. Larger studies are needed to confirm these findings. Interventions to standardize breast cancer risk assessment in primary care may improve equity.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 2