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.
The association between insurance status and timely diagnostic resolution after a positive screening mammogram test result likely depends on patient risk factors as well as the presence or absence of breast cancer. The proposed research will identify which patient factors work in combination with insurance status to affect time to diagnostic work-up and resolution. These results will aid in our understanding of the disparities observed in the breast cancer care continuum.