ASPO Abstracts
Financial Constraints on the Use of Breast Cancer Risk-Management Care among a Community-Based Sample of High-Risk Women.
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Background: Clinical guidelines recommend risk-management care for women with an estimated ≥20% lifetime risk of breast cancer (BC). Yet, use of guideline- concordant care is low and reasons for the low use are not well understood. The study aimed to examine the associations between financial constraints (health insurance continuity, feelings about present income, and competing financial demands) and use of risk-management care (genetic testing, genetic counseling, and breast or cancer specialist visits). Methods: Non-Hispanic Black or white women aged 18-74 years, with no prior history of cancer, and ≥ 20% lifetime BC risk were recruited from online research volunteer databases, social media, and clinics. Participants completed an online survey about family history, decision-making factors, and risk-management behavior. We used descriptive statistics to calculate proportions and logistic regression to estimate odds ratios and 95% confidence intervals. Results: A total of 717 Black (35%) and white women (65%) completed the survey. Most (92%) were currently insured, but 54% reported previous insurance disruptions and only 40% reported 'living comfortably' on present income. We observed low use of genetic counseling (31%), genetic testing (36%), and discussions of BC risk with specialists (43%). Disrupted insurance was associated with lower odds of genetic counseling (OR=0.55 [95% CI: 0.38, 0.80]), genetic testing (OR=0.70 [95% CI: 0.48, 1.03]), and specialist care (OR=0.59 [95% CI: 0.41, 0.85]). Similar associations were observed for perceived financial hardship and use of risk-management care. Compared to partnered-with-children households, all other family structure types had lower odds of use for all three risk- management services. Single mother households had the lowest odds of use of all three risk-management services (ORs: 0.17–0.33 [95% CIs: 0.21–0.57). Neither being a caretaker to an adult nor managing chronic health condition(s) were significantly associated with the use of risk-management care. Conclusions: Financial constraints are associated with lower use of risk-management care. Future work should continue to investigate how the complexities of financial factors constrain BC risk management and develop strategies to help mitigate their impact.
Keywords: Breast cancer prevention, breast cancer risk, risk-management care, financial constraints