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Background
Breast cancer is the leading cause of new cancer diagnoses and in 2021 was the leading cause of death among women in the United States. Mammographic screening is the mainstay of prevention; however, the COVID-19 pandemic has decreased mammography rates by up to 85%. COVID-19 has caused disproportionate devastation in marginalized communities, highlighting how social determinants of health (SDOH) perpetuate differences in breast cancer incidence, stage at diagnosis, morbidity, and mortality. These SDOH are difficult to characterize because they exist at the patient-, provider-, neighborhood-, and health system-level. Previous discussions on targeting SDOH have focused on fixing the “downstream” consequences of health inequity–rather than tackling disparities at their “upstream” source. Recent interventions combating these “upstream” inequities including institutional racism and socioeconomic barriers have used a framework of community partnerships to great effect. This socially-conscious and cost-effective method has improved screening rates and quality-adjusted life-years. By establishing bidirectional academic-community partnerships, mutually valuable interventions can be tailored to a community’s specific needs. This exhibit will serve as a health equity primer and will outline how radiologists can leverage their unique role to address missed care opportunities.

Educational Goals / Teaching Points
In this exhibit, we will outline disparities in breast cancer, effects of COVID-19, key concepts of SDOH, intervention methods, and emphasize the role of radiologists in mitigating health inequities.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A case series will show how SDOH can present in the clinical setting. Case 1 features a 61-year-old uninsured woman presenting for screening mammography with no prior screening history. Images consist of mammogram, ultrasound, and MRI maximum intensity projection (MIP), and findings consistent with invasive mammary carcinoma with metastatic disease. Case 2 features a 44-year-old under-insured Honduran woman with limited English proficiency presenting with bloody nipple discharge. Images consist of mammograms, ultrasound, and MRI MIP, and findings consistent with high-grade ductal carcinoma in situ and metastatic adenocarcinoma.

Conclusion
The pandemic has highlighted the detrimental effects of SDOH on breast cancer care. Upstream factors can be identified and mitigated with a multipronged approach involving meaningful engagement with the community; some examples of effective interventions include arranging same-day breast biopsies, integrating patient navigators, and providing need-based social support. As the providers at the interface between a patient and their cancer journey, radiologists have special opportunities to tackle health inequity both within and outside the hospital. Radiologists can participate as educators who improve their community’s health literacy, as researchers who identify and distill their patients’ upstream obstacles, as leaders who spearhead community partnerships, and as advocates for social change—all contributing to a more equitable healthcare landscape.