Screening Mammography: Early Breast Cancer Detection for All at Risk

Although cancer screening mammography saves lives, previous, relatively small studies suggest some individuals who are eligible for screening are not screened. For example, sexual minority (SM) groups of people generally remain inaccessible to research and are not screened for breast cancer. This K23 career development application seeks to learn how many of these screening-eligible individuals are not screened for breast cancer and why. In aim 1, we propose to acquire the necessary – but unknown -- benchmark data on the actual rates of cancer screening mammography in SM individuals who should be screened and to identify factors associated with screening or lack thereof. We propose to interrogate and analyze data from a 200 million-patient insurance claims database (the national Optum Labs Data Warehouse). To identify SM patients, we will explore medical visit coding information. We will report cancer screening mammography rates in these SM individuals and compare these rates to the general population. This first aim promises to provide robust data on cancer screening mammography in SM individuals and will be crucial in planning potential future studies to improve screening rates in this population. In aim 2, the principal investigator (PI) will undertake qualitative interviews of SM individuals who are 40+ years of age (40 years is the age when screening mammography typically starts) to understand these individuals’ thoughts on screening mammography (and on other cancer screening). These in-depth interviews will allow us to learn directly from these individuals how life-saving cancer screening procedures can be made more accessible. These 2 aims – in conjunction with the completion of relevant coursework and ongoing interactions with a multidisciplinary team of senior mentors (an endocrinologist; a medical oncologist; a statistician; a qualitative researcher; a primary care physician; and an epidemiologist who focuses on screening mammography) -- will enable the PI, a medical oncologist, to develop the necessary skills to emerge as a national leader in cancer care in underscreened individuals. The ultimate goal of this research is to help SM individuals receive the same lifesaving benefits of cancer screening as the general population.