ASPO Abstracts
Financial Constraints on Breast Cancer Risk-Management Decisions Among Women at Elevated Risk
Category: Financial Hardship Associated with Cancer
Conference Year: 2020
Abstract Body:
Background: Women at elevated risk of breast cancer, due to BRCA mutations or strong family
history, are advised to consider various risk-reduction options (e.g., enhanced screening,
prophylactic surgeries, or preventive medication). These options are under-utilized and financial
barriers may be one explanatory factor. Financial toxicity of cancer treatment is well-studied.
Financial barriers to cancer prevention, however, are often described by simple proxy measures
(e.g., income level or insurance status) that existing research suggests fail to capture the
magnitude and mechanisms by which financial barriers impede preventive action.
Purpose: To identify the health-related financial constraints experienced by high-risk women
and document the cancer risk-reduction behaviors affected. Methods: Semi-structured
interviews were conducted with 20 African American and 30 White women at elevated risk of
breast cancer. Inductive methodology with a directed content analysis approach was used.
Results: Sixty percent reported a wide range of financial constraints, which fall into 3 themes:
(1) current or history of no insurance (2) under-insurance (i.e., limited coverage, high out-of-
pocket costs) and (3) other financial constraints (e.g., medical debt, raising children, managing
comorbidities, and affording to take time off work). Over half of women with financial constraints
experienced major delays or prevention of risk-management actions (e.g., breast screenings,
genetic counseling or testing, prophylactic mastectomy, or oophorectomy). Twenty-two percent
of women also reported perceptions of insurance companies that impacted their decision
making; these concern lack of price transparency, gaps in knowledge about covered
procedures, and distrust. Conclusions: Our findings highlight the centrality and complexity of
financial constraints in women’s breast cancer risk management. Effective methods to address
financial constraints and perceptions may include tailored support interventions, patient
navigation, cost conversations between providers and patients, or referral to financial support
services. Policies to reduce premiums and out-of-pocket costs would expand access to
affordable health insurance and may promote utilization of preventive breast cancer services.
Keywords: cancer prevention, financial constraints, qualitative research