Assessing Breast Cancer Screening Gaps in the Emergency Department

Breast cancer is one of the most commonly diagnosed cancers and ranks second in cancer related mortality among women. Appropriate screening and early detection are paramount in the successful treatment of this disease. The emergency department (ED) provides a unique opportunity to interface with patients with limited access to the healthcare system. The primary aim of this project was to characterize the extent of unmet breast cancer screening needs among ED patients, with the goal of informing the feasibility of future ED based identification and linkage to screening initiatives.

This was a prospective, observational study conducted over a nine-month period (June 2023 to February 2024) in a single large urban emergency department (ED) in the southeastern United States. Female patients aged 40-74 presenting to the ED with moderate to low acuity complaint were approached by research staff and guided through a 10-minute questionnaire to assess screening history, access to care, and individual risk of developing breast cancer. Patients were excluded if they had known active breast cancer, terminal illness, active pregnancy, were incarcerated/in custody, or were otherwise unable to participate in questionnaire. We utilized the Tyrer-Cuzick screening model to estimate breast cancer risk. Screening eligibility was determined based on guidelines from the American Cancer Society (among many other professional organizations) which recommend annual mammography beginning at age 40.

A total of 90 patients were enrolled. Median age at enrollment was 59, 11% were uninsured, and 13% lacked a primary care provider. Thirty-seven individuals (41.11%) were found to be due for breast cancer screening. We additionally identified 6 individuals (6.7%) who were at increased lifetime risk (>20%) for developing breast cancer. Patients were more likely to be due for breast cancer screening if they were uninsured (70% vs 36.3%, p = 0.04) or lacked primary care (75.0% vs 34.6%, p = 0.008).

An ED based approach to assessing breast cancer risk identified a substantial proportion of patients who were due for screening. Even higher rates were observed in individuals who were uninsured and/or lacked a primary care doctor. Overall, these results highlight an underlying need in our healthcare system and potential opportunity to increase access to care and early detection of breast cancer.