The state-run, federally funded North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides breast cancer screening services to underserved North Carolinian women to mitigate disparities in access to care. In a recent study published in the journal Cancer, researchers investigated how the program is working (2021; doi.org/10.1002/cncr.33473).
The key questions to answer were: "How has NC BCCCP affected the care of women? And what lessons can we learn with regards to mitigating disparities in care?" explained one of the researchers Oluwadamilola Fayanju, MD, who is now the Helen O. Dickens Presidential Associate Professor and Chief of Breast Surgery at Penn Medicine (but was Associate Professor of Surgery and Population Health Sciences in the Duke University School of Medicine when she worked on the research).
The data revealed both encouraging and discouraging results, she explained to Oncology Times in an interview. Here's what she said about the research, including what's important for all practicing oncologists to know.
1 What would you say were the key findings from this research and why?
"What was really exciting and heartening to see was that over the course of this study period-we examined women who had been screened for breast cancer from 2008 to 2018-there was really high quality of care provided. Across all groups, women were receiving treatment within 1 month of presentation, which is very much in line with the type of guidelines that you see from the CDC. So these [examples of] timeliness are really achievements in a population that is at high risk for having delays in care.
"But what we did find, too, is that when we controlled for race, we still found a disparity among Black women relative to White women in terms of relative delays [from screening] to time of diagnosis, and then among Black and Hispanic women relative to White women [from screening] to time of treatment.
"So that is to say, across all groups, yes, we are seeing a timely receipt of treatment, but when you drill down by race, there is still a difference between Black and Hispanic women versus White women. These findings tell us that, even in a program that is providing high-quality care to underserved people, there are still persistent racial and ethnic disparities in timeliness of care. So there's still work to be done."
2 What type of work and interventions might help address some of these disparities?
"I think the main thing we'll need to do is really partner with the primary care providers who are utilizing NC BCCCP to make sure that each of those primary care providers has sufficient support for getting these women into care.
"We know that provision of care in this country is often racially segregated. Providers of color disproportionality take care of patients from ethnic and racial minority groups and are disproportionately working in less well-resourced sites-departments of public health or federally qualified health centers, as opposed to private clinics. So there's a systemic tendency towards the place of care to be less well-resourced for people of color. And that can then lead to the downstream effect of fewer people being able to check up on them when there's a delay, less opportunity for there to be a follow-up phone call or visit to ensure that care is happening in a timely fashion, or fewer technological resources, like EHRs, that will allow for tracking.
"So all of this means that there are systemic contributors to why people are more likely to fall through the cracks, and more likely to have a delay in time to evaluation and time to treatment.
"Working with primary care providers, recognizing that those who disproportionately serve Black and Brown communities might be more strained across all dimensions, and really working to make sure those sites of care are adequately resourced and supported with personnel who can provide the type of follow-up that these types of patients are more likely to need will be important."
3 So, what's the bottom line that practicing oncologists and cancer care providers should know about this work?
"As oncologists, we increasingly need to embrace partnering with primary care providers in order to optimize oncologic outcomes for those at greatest risk for poor quality care.
"I think it's very easy in our health care system to dichotomize primary care and subspecialty care. I'm an oncologist and a surgeon. So it seems like what I do is far removed from what someone in internal medicine does. But actually our work is very intertwined. And the better the primary care support for our patients, the better oncologic screening and care we can provide.
"I think that is the future: better partnerships between primary and specialty care. And I think that needs to happen across all types of care practices and care models. To achieve high-value primary and subspecialty care, lines need to be deliberately and intentionally blurred so that we really think about care in a holistic fashion for our patients and patients to be."