Abstract C138: Barriers to screening and diagnostic testing among patients with a confirmed triple negative breast cancer (TNBC) diagnosis

Abstract

Introduction Triple negative breast cancer (TNBC) is an aggressive form of breast cancer that disproportionately affects people of racial and ethnic minority groups. TNBC is associated with poorer prognosis and lower long-term survival rates versus other subtypes. Understanding access to routine services like mammography and genetic testing may reveal areas for process improvement and enable equitable healthcare delivery. The objective of this study is to assess how screening, diagnosis, and genetic testing were described by race using a physician survey and patient-chart review. Methods Data collection consisted of a 60-min physician survey and linked retrospective review of patients’ charts conducted June-July 2022. Participating oncologists across the US (34% Central; 19% Southeast; 18% Northeast; 21% West; 9% East Coast) were required to be board-certified, in practice 3-30 years post-residency, and managing  ≥ 7 patients with TNBC in the past 3 years. Oncologists extracted patient-level data from 2-4 patient records for the chart review. Selection of charts oversampled patients on Medicaid, Black and Latina patients, and patients with later stage TNBC to allow for robust disparities analyses. Data collected included tests and diagnostic procedures performed, rationale for tests and procedures, and barriers experienced in accessing care. Results 101 oncologists (73% male; 62% community vs 39% academic setting) provided information on 283 patients with TNBC [99% female; median age=46 years; race= 42% Black, 31% Latina, 25% White, 2% Other]. Most first-time mammograms were performed due to identification of symptoms (68%) as compared to annual screening (28%) or family history (4%). White patients were more likely to have a first-time mammogram for annual screening (40%) compared to Black patients (22%). Black patients were more likely to have a first-time mammogram due to identification of symptoms (72%) compared to White patients (58%). Oncologists perceived that few (4%) of their patients experienced barriers to mammogram access, though they perceived higher rates of barriers among Black patients (6%) than Latina (4%) or White (3%) patients. They listed cost, scheduling, and access to clinics as the predominant barriers patients experienced. Oncologists perceived that most patients (77%) encounter difficulty in accessing genetic testing; this varied by race, with oncologists reporting that 93% of Black patients, 86% of Latina patients, and 50% of White patients encounter difficulty in accessing genetic testing. Conclusions This study described oncologists’ perceptions of screening and diagnostic testing among patients with a confirmed TNBC diagnosis. Reasons for first-time mammogram differed by race (routine screening vs family history vs symptomology); Black patients were less likely to have a first-time mammogram for annual screening and Black and Latina patients were more likely to experience difficulty in accessing genetic testing. These barriers could delay diagnosis and impact treatment decisions, exacerbating existing disparities.

Citation Format: Langa Bakhuluma-Ncube, Emily Fox, Laura Okpala, Natalia Sadetsky, Matt O’Hara, Jennifer Parr. Barriers to screening and diagnostic testing among patients with a confirmed triple negative breast cancer (TNBC) diagnosis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C138.