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Racial and Socioeconomic Disparities in Breast Cancer Diagnostic Work Up and Outcomes

乳腺癌诊断工作和结果的种族和社会经济差异

基本信息

批准号：
10094564
负责人：
CHRISTOPH I LEE
金额：
$ 66.06万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-01 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10094564
关键词：
Address Adherence Advanced Malignant Neoplasm Affect Biometry Biopsy Breast Cancer Detection Breast Cancer Epidemiology Breast Cancer Surveillance Consortium Breast biopsy Cancer Diagnostics Caring Characteristics Complex Consultations Continuity of Patient Care Data Data Science Data Sources Decentralization Diagnosis Diagnostic Diagnostic Imaging Education Ethnic Origin Evaluation Failure Future Goals Guidelines Health Health Services Research Image Image Guided Biopsy Imaging technology Individual Insurance Intervention Link Low income Malignant Neoplasms Mammographic screening Mammography Mediating Mediation Medicine Minority Morbidity - disease rate Nature Observational Study Operative Surgical Procedures Outcome Play Policies Population Positioning Attribute Practice Guidelines Procedures Provider Quality of Care Race Radiology Specialty Registries Research Resolution Role Service provision Services Socioeconomic Status Specialist Stage at Diagnosis Statistical Models Survival Rate Testing Time Tissues Transportation Ultrasonography Underinsured Vulnerable Populations Woman advanced breast cancer base black women breast cancer diagnosis breast imaging burden of illness cancer health disparity cancer imaging care coordination care episode clinically significant data resource diagnostic technologies ethnic minority population experience follow-up health care delivery health care disparity innovation low socioeconomic status malignant breast neoplasm mortality multilevel analysis multiple data sources novel novel diagnostics practice factors racial and ethnic racial disparity rural residence screening screening disparities socioeconomic disadvantage socioeconomic disparity standard of care tumor

项目摘要

Project Summary U.S. women of minority race/ethnicity, lower education, lower income, rural residence, and the underinsured experience higher breast cancer disease burden and lower survival rates than women without these characteristics, despite recent improvements in screening access and treatments. The majority of efforts to mitigate these disparities have focused on screening mammography access, but women must navigate multiple additional steps when cancer is suspected, including more imaging, biopsies, and specialist consultations. Each year, >12 million U.S. women enter this diagnostic care continuum. Failure to receive timely, quality evaluation leads to delayed diagnosis, more invasive procedures, advanced cancer stage at diagnosis, and greater mortality. Compared to screening, surprisingly little is known about disparities during this diagnostic period. It is estimated that up to 30% of women with abnormalities detected by mammography fail to obtain appropriate or timely follow-up, and up to 50% of racial/ethnic minorities and socioeconomically disadvantaged women experience such failures. A clearer understanding of disparities along the diagnostic continuum is hindered by the decentralized nature of breast cancer screening and diagnosis in the U.S., with disparities in care likely due to a complex combination of individual, residential, and healthcare delivery factors. We propose to conduct the largest U.S. observational study of disparities in diagnostic breast imaging to date. Specifically, we aim to 1) identify specific subpopulations of women with lower access to and use of key diagnostic imaging technologies; 2) determine differences in diagnostic outcomes that can serve as quality of care indicators based on race/ethnicity and socioeconomic status; and 3) identify differences in timeliness of diagnostic evaluation among disparities populations. We will use multi-level statistical modeling and mediation analyses to account for multifactorial interactions that likely influence inequitable diagnostic care. Our team, the Breast Cancer Surveillance Consortium, consists of national experts in breast cancer epidemiology, biostatistics, health services research, medicine, and radiology. The BCSC represents the largest longitudinal breast cancer imaging data resource linked to long-term outcomes that is representative of the general U.S. population by race/ethnicity. We systematically collect woman-, exam-, residential-, practice-, provider- and tumor-level data across seven regional registries and more than 200 individual practices. With data collected for 13 million breast imaging exams, 5.5 million of which were performed among traditional disparities populations, our team is well-positioned to carry out the proposed analyses. Our study will help shift the breast cancer disparities research paradigm from focusing on screening access to evaluating the entire diagnostic episode. By identifying novel quality of care metrics and “early warning” indicators of disparities, our results will inform both practice-level interventions aimed at closing local disparities gaps and national practice guidelines and policies directed towards more equitable breast cancer diagnostic evaluation.

项目总结