Provider effects and racial inequities in breast cancer risk-management adoption: Findings from a community-based study of high-risk women.

Abstract

We investigated the role of high-risk patients' relationships with their provider (hereafter, "patient-provider relationships" (PPRs)) in risk-management decision making among women with a high risk of breast cancer (BC) and examined racial disparities in three healthcare provider (HCP)-related facilitators of BC risk-management awareness and adoption. Using a community-based online survey of 717 non-Hispanic Black and non-Hispanic white women with ≥ 20 % lifetime risk of BC, we assessed the effects of HCP-related facilitators, identified by our previous research, on BC screening uptake and awareness of preventive options using logistic regression. All three HCP-related facilitators were associated with an increased likelihood of being concordant with screening recommendations and aware of preventive options. Black women were less likely to report having access to the facilitators, and they were less likely to be concordant with and aware of risk-management recommendations. Targeted health interventions focused on improving specialist access and risk-related expertise among generalists, particularly among Black women, could substantially improve equity in BC prevention and screening access, and ultimately in BC outcomes. Providers should address BC risk proactively with their patients, particularly among those with hereditary risk, and work to establish trusting relationships with their patients.