(9) Mammography Screening Disparities in Urban Patients with Substance Use Disorder

Mammography Screening Disparities in Urban Patients with Substance Use Disorder
Lorien Shack, MD, Emily Gordon, MD, Pauline Thomas, MD Department of Internal Medicine, Rutgers University, Newark, NJ.

Introduction:
Recent literature has described the relationship between substance use and overdose, infection, and certain cancer diagnoses. However, there is a paucity of knowledge surrounding the impact of substance use and malignancy screening. Building on a JAMA article demonstrating that the quality of preventive care for those with opioid use disorder (OUD) was lower than those without, this study investigates the impact of all substance use disorders (SUD) on breast cancer screening in an urban safety-net hospital.

Breast cancer accounts for 14.8% of all cancer cases, however, is treatable if diagnosed early, with a 5-yr survival of 90.3%. Given the disparities that exist regarding successful treatment after breast cancer diagnosis in the SUD population, early diagnosis is even more imperative with a goal of reducing morbidity and mortality. The purpose of this study is to characterize the current mammography screening disparities, identify systemic barriers, and begin building the framework for closing gaps in prevention for those with SUD.

Methods:
This study identified 285 Horizon Blue Cross Blue Shield Medicaid records at University Hospital (UH), a large public hospital in Newark, NJ, of women who, in 2021, were due for their screening mammography according to USPSTF guidelines. After exclusion criteria, 247 charts were reviewed for mammography completion, last primary care visit, order placement and current diagnosis of SUD as identified by physician note. JMP statistical analysis software was used to evaluate the quantitative, qualitative, and demographic data.

Results:
Of the 247 women, 71% were Black, 22% Latinx, and 84% were unemployed. The overall prevalence of mammography completion was 61%, however, prevalence of completion was 49% (34/70) in those with SUD compared to 66% (117/177) in women without SUD. Women at University Hospital with SUD are less likely to complete mammography than those who do not have SUD [OR = .49, 95% CI = 0.28, 0.85]. Additionally, women with SUD were less likely to have the order placed by a physician [OR= 0.60, 95% CI =0.33, 1.1].

Conclusion:
Medicaid patients at University Hospital, who have SUD are less likely to complete recommended screening mammography and less likely to have been referred for mammography then women who do not. Characterizing this issue can lead to improved care through earlier breast cancer diagnosis, decreasing morbidity and mortality in a population with many barriers to treatment follow up.

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