Financial Constraints on Breast Cancer Risk-Management Decisions Among Women at Elevated Risk

• In Event: 4122 - Section on Medical Sociology Refereed Roundtables (60 min)
  In Refereed Roundtable (60 min): Table 18. Health Disparities

Abstract

Background: Women at elevated risk of breast cancer, due to BRCA mutations or strong family history, are advised to consider various risk-reduction options (e.g., enhanced screening, prophylactic surgeries, or preventive medication). Utilization rates of these options are low and financial barriers may be one explanatory factor. Financial toxicity of cancer treatment is well-studied. However, financial barriers to cancer prevention are often described only by simple proxy measures (e.g., income level or insurance status) that existing research suggests fail to capture the magnitude and mechanisms by which financial barriers impede preventive action.

Purpose: To identify the health-related financial constraints experienced by high-risk women and document how cancer risk-reduction behaviors are affected.

Methods: Semi-structured interviews were conducted with 20 African American and 30 White women at elevated risk of breast cancer. Inductive methodology with a directed content analysis approach was used.

Results: A majority of participants reported experiencing a wide range of financial constraints, which fall into 3 themes: (a) current or history of no insurance (b) under-insurance (i.e., limited coverage, high out-of-pocket costs) and (c) other financial constraints (e.g., medical debt, raising children). Over half of women with financial constraints experienced major delays or prevention of risk-management actions. Almost a quarter of participants also discussed perceptions of insurance companies that impacted their decision making; these concern lack of price transparency, gaps in knowledge about covered procedures, and distrust.

Conclusions: Our findings highlight the centrality and complexity of financial constraints in women’s breast cancer risk management. Effective methods to address financial constraints and perceptions may include tailored support interventions, patient navigation, cost conversations between providers and patients, or referral to financial support services. Policies to reduce premiums and out-of-pocket costs would expand access to affordable health insurance and may promote utilization of preventive breast cancer services.

Authors

• Rachel Meadows, The Ohio State University College of Public Health

• Tasleem Juana Padamsee, The Ohio State University