Insurance type and diagnostic resolution disparities in breast cancer screening

描述（由申请人提供）：在40-74岁的女性中，常规筛查乳房x光检查与乳腺癌死亡率降低15-20%相关。影响疾病死亡率的筛查行为的一个重要但研究较少的方面是乳房x光筛查阳性结果后适当的随访护理。低收入和少数族裔妇女不太可能接受筛查性乳房x光检查，与其他妇女相比，更有可能经历等待诊断结果阳性筛查检查的时间增加。由于得不到充分服务的妇女通常被诊断出患有更晚期的疾病，并且乳腺癌死亡率更高，因此迫切需要了解这一高风险群体中等待时间增加的原因。这项研究的长期目标是确定可用于更好地了解乳腺癌筛查差异的患者因素。使用来自卡罗来纳州乳房x线摄影登记处（CMR）的标准化数据，这是一个前瞻性的基于人群的乳房x线摄影登记处，拟议的研究将解决以下3个具体目标：1)评估保险类型与在大量种族多样化的人群中进行阳性筛查乳房x线摄影后诊断解决方案之间的关系；2)评估种族、农村/城市居住、成像方式（数字/胶片）、乳腺癌家族史和乳腺密度对保险类型和诊断分辨率之间关系的影响程度；3)确定假阳性结果如何影响保险类型与乳房x光筛查阳性结果后诊断解决方案之间的关系。我们认为，由于CMR数据的几个独特优势，拟议的研究具有创新性：具体而言，包括大量少数民族和农村人口，以准确评估差异，乳腺癌家族史和乳腺密度的患者水平数据，放射科医生对筛查乳房x光片的评估，以及CMR与病理数据和州癌症登记数据的联系，以确定癌症结局。拟议的研究将为我们提供关于患者亚组之间存在的诊断检查和阳性筛查乳房x光检查后解决方案的差异程度的数据。申请人渴望成为一名独立和富有成效的癌症流行病学家，专注于差异和卫生服务研究。拟议的培训计划是为使申请人参与多学科研究而量身定制的，包括正式的教学教育、导师监督的学习、应用技能培训和职业发展活动。在整个奖项期间，申请人将接受一个跨学科团队的指导，该团队在癌症流行病学、乳腺癌筛查、卫生服务研究和生物统计学方面具有专业知识。

DESCRIPTION (provided by applicant): Routine screening mammography has been associated with a 15-20% reduction in breast cancer mortality among women ages 40-74 years. An important, but less studied dimension of screening behavior that impacts disease mortality is appropriate follow-up care after a positive screening mammogram result. Low-income and minority women are less likely to undergo screening mammography and are more likely to experience increased wait time for diagnostic resolution of a positive screening exam compared with other women. Because underserved women are typically diagnosed with more advanced disease and have higher breast cancer mortality rates, there is an urgent need to understand the increased wait times among this high risk group. The long term goal of this research is to identify patient factors that can be used to better understand disparities in breast cancer screening. Using standardized data from the Carolina Mammography Registry (CMR), a prospective population-based mammography registry, the proposed research will address the following 3 specific aims: 1) Assess the relationship between insurance type and diagnostic resolution after a positive screening mammogram in large, racially diverse population; 2) Evaluate the extent to which race, rural/urban residence, imaging modality (digital/film), family history of breast cancer, and breast density modify the relationship between insurance type and diagnostic resolution; 3) Determine how a false positive result impacts the relationship between insurance type and diagnostic resolution after a positive screening mammogram result. We believe the proposed research is innovative because of several unique strengths of the CMR data: specifically, the inclusion of a substantial minority and rural population with which to accurately assess disparities, patient level data on family history of breast cancer and breast density, the radiologists' assessment of the screening mammogram, and the linkage of CMR to pathology data and state cancer registry data for determining cancer outcomes. The proposed research will provide us with data on the extent to which variations among patient subgroups exist for diagnostic work-up and resolution after a positive screening mammogram. The applicant aspires to become an independent and productive cancer epidemiologist with a focus on disparities and health services research. The proposed training plan is tailored to engage the applicant in multidisciplinary research and includes formal didactic education, mentor-supervised study, applied skills training, and career development activities. Throughout this award, the applicant will be mentored by an interdisciplinary team with expertise in cancer epidemiology, breast cancer screening, health services research, and biostatistics.