Researcher(s)
- Medha Annam, , University of Delaware
Faculty Mentor(s)
- Heather Bittner Fagan, Family and Community Medicine, ChristianaCare
- Karen Antell, Family and Community Medicine, ChristianaCare
Abstract
Title: Bringing Light: Opportunities Missed in Breast Cancer
Background
Despite having similar breast cancer incidence rates to White women, Black women have a 40% higher mortality rate, with women under 50 years of age experiencing an even greater disparity. A geographical hotspot for advanced-stage diagnosis of breast cancer has been identified in Wilmington, Delaware. Considering how having a primary care physician (PCP) and continuity of care are associated with improved preventative health, this study aims to understand how younger women diagnosed with advanced breast cancer in Wilmington interacted with primary care leading up to their diagnosis.
Methods
Patients residing in the Wilmington hotspot, diagnosed with advanced-stage breast cancer, under 51 years of age, and with at least 4 years of primary care history were identified using Helen F. Graham Cancer Center & Research Institute registry data. Retrospective timelines were constructed, documenting interactions with primary care prior to patient diagnoses. Descriptive statistics and continuity of care indexes (COCI) were calculated, and key themes were identified.
Results
All patients had a family history of breast cancer, with 67% having a family history of ovarian or breast cancer. In this cohort, 67% did not disclose this information until after diagnosis or were not asked. Clinical/symptomatic method of diagnosis was the most common (89%). Patients who waited the longest to present breast symptoms to their providers reported socioeconomic struggles. Low COCIs (M = 0.173) indicate the patients may have experienced difficulties in receiving consistent medical care. Patients who primarily saw attendings (33%) had the highest PCP COCIs while patients who displayed anxiety toward treatment (33%) had the lowest PCP COCIs.
Conclusions
Preliminary findings suggest that continuity of care, thorough discussions of risk factors, and increased emphasis on physicians asking about family history may lead to earlier identification of women at high-risk for breast cancer and effective preventative care measures.