M.S. House1, G. Hamilton-Fletcher2, C. Lam3, J. Rizzo4,5,6, K. Joseph6,7,8 1NYU Grossman School of Medicine, New York, NY, USA 2NYU Langone Health, New York, NY, USA 3NYU Langone Health, Initiative For Women With Disabilities, New York, NY, USA 4NYU Grossman School of Medicine, Department Of Physical Medicine And Rehabilitation, New York, NY, USA 5NYU Grossman School of Medicine, Department Of Neurology, New York, NY, USA 6NYU Langone Health, Institute Of Excellence In Health Equity, New York, NY, USA 7NYU Grossman School of Medicine, Department Of Surgery, New York, NY, USA 8NYU Grossman School of Medicine, Department Of Population Health, New York, NY, USA
Introduction: Significant disparities exist in breast cancer screening, detection, and treatment for women with disabilities. The reasons for these disparities have not been studied extensively and are poorly understood, limiting efforts towards equity. In this study, we evaluate rates of mammogram screening at a clinic providing gynecological care for women with disabilities.
Methods: We examined a retrospective cohort of 189 women receiving care at the NYULH Initiative for Women with Disabilities (IWD) from February 2023 through January 2024. We reviewed the charts of all women seen in the clinic during this period and excluded one participant who passed away during the study year. The primary outcome was the rate of adequate breast cancer screening. Secondary outcomes included breast exam rate, barriers to breast cancer screening, and imaging rates by race, ethnicity, and insurance type (Medicaid, Medicare, private, uninsured).
Results: 138 of 189 (73%) participants were recommended for screening per ASBrS guidelines: annually for women over 40 years old or earlier for women with a first-degree family history. Of recommended participants, only 72 (52.2%) received screening mammograms (SMs) within an appropriate time window. Of the 72 participants who received SMs, 13 (18.1%) of mammograms had views limited by “wheelchairs” or “patient immobility.” Only 52 women (42.8%) met screening guidelines. Among 138 women recommended for a SM, 8 (5.8%) received a breast ultrasound instead of a SM, which is not standard of care. 8% of all women were missing a documented breast exam. Most patients, 83.1%, had requests for mobility-related accommodations. There were no significant differences in primary or secondary outcomes by race, ethnicity, or insurance type.
Conclusion: Low screening rates and inadequate screening persist for women with disabilities. Even in an urban academic hospital, barriers exist in the acquisition of appropriate accommodations for indicated care. The IWD is a specialized center that advocates for and supports the healthcare of women with disabilities, which leads us to believe that SM rates may be even lower in the general population of women with disabilities. Further studies should be done to elucidate the structural barriers preventing this group from accessing screening and receiving the necessary accommodations for adequate diagnostic imaging. Ultimately, this work should be used to mitigate perpetuated disparities in care for this vulnerable population.