E4538. Disparities in Breast Cancer Imaging Access and Diagnosis Across Races and Insurance Status
  1. Juliana Sitta; University of Mississippi Medical Center
  2. Seth Lirette; University of Mississippi Medical Center
  3. Candace Howard; University of Mississippi Medical Center
To analyze disparities in breast cancer diagnosis and breast imaging access between races and financial classes in a major academic institution in Mississippi.

Materials and Methods:
Data from breast cancer patients was retrospectively analyzed utilizing the patient cohort explorer, an institutional application that contains de-identified data from electronic medical records including over 800,000 patients registered at University of Mississippi Medical Center. Inclusion criteria was breast cancer diagnosis between 2016 to 2020 and female gender. Information collected from the database included race, age, body mass index (BMI), financial class, vital status, clinical stage at presentation, and imaging modalities performed. Patients with incomplete data were excluded. The final sample included 738 patients.

Mean BMI was higher among Black individuals compared to Whites, yet similar across insurance classes. There were slight differences in insurance type between races, with a higher proportion of Black women being enrolled in Medicaid relative to White women (16% vs. 9%, respectively. P = 0.025). Mean days to return for a diagnostic mammogram following an abnormal screening were not significantly different based on either race or insurance class. Breast MRI rates were similar between White and Black populations. However, private insurance beneficiaries displayed notably higher rates of MRI usage compared to those covered by Medicaid or Medicare (31% for private insurance beneficiaries vs 16% and 19% for Medicaid and Medicare, respectively. P < 0.001). Regarding stage, approximately half of White women were diagnosed at Stage 1 while Black women tended to be diagnosed at more advanced stages (P <0.001). Medicaid beneficiaries were disproportionately diagnosed at stage 3 and stage 4, significantly surpassing rates observed in the private insurance and Medicare groups (P <0.001).

The findings in this preliminary study underscore the complex interplay between race, insurance coverage, and breast cancer stage at diagnosis among this population. The elevated BMI observed in Black individuals compared to White individuals underscores potential metabolic differences between these groups. The promptness of diagnostic mammogram follow-ups, an important component of timely diagnosis, did not vary significantly based on race or insurance type. While MRI rates remained comparable between White and Black populations, the notable disparity in MRI usage between private insurance beneficiaries and those covered by Medicaid or Medicare highlights potential access barriers. Notably, breast cancer diagnosis at advanced stages was more prevalent among Black women and Medicaid recipients indicating potential disparities in healthcare access and possible cultural barriers. These findings collectively highlight the intricate intersections of race and insurance status in shaping healthcare experiences and could play a significant role in outcomes. Further research and targeted interventions and outcomes are essential to address these disparities and promote equitable health outcomes.