Cancer Med. 2026 Jul;15(7):e72075. doi: 10.1002/cam4.72075.
ABSTRACT
BACKGROUND: Clinical guidelines recommend risk-management care for women with ≥ 20% lifetime risk of breast cancer (BC). Yet, guideline-concordant care-including conversations about BC risk with specialists-is low, and driving factors are not well understood. This study examined (a) associations between the material, psychosocial, and behavioral domains of financial constraint and BC risk conversations with genetics specialists and cancer/breast care specialists, and (b) whether competing resource demands are associated with the specialist BC conversations when controlling for insurance status (to disentangle the role of behavioral factors from material and psychological ones).
METHODS: Non-Hispanic Black or white women aged 18-74 years, with no history of cancer and ≥ 20% lifetime BC risk were recruited from online research volunteer databases, social media, and clinics. Participants completed an online survey about personal/family history, decision-making factors, and risk-management behavior. We used descriptive statistics to calculate proportions and both adjusted and unadjusted logistic regression to estimate odds ratios and 95% confidence intervals.
RESULTS: A total of 662 Black (34%) and white (66%) high-risk women comprised the analytic sample for this paper. Overall rates of specialist BC risk conversations were low: 43% had discussed their BC risk with any specialist (genetics specialist, breast specialist, and/or cancer specialist). In multivariate logistic regressions adjusted for race and age, perceived financial hardship was associated with lower odds of BC risk conversations with genetics (OR = 0.42 [95% CI: 0.25, 0.70]) and breast/cancer specialists (OR = 0.39 [95% CI: 0.24, 0.65]). Similar associations were observed for the relationships between disrupted insurance or single motherhood and specialist risk conversations.
CONCLUSIONS: Limited financial and other resources are associated with lower rates of BC risk conversations with specialists, which are critical to risk management in high-risk women. Future work should further investigate the complexities of resource limitations in BC risk management and develop mitigation strategies.
PMID:42470205 | DOI:10.1002/cam4.72075
