How do healthcare providers approach breast cancer diagnoses in young women? Findings from the BRAVE Study

Background: Young women face unique challenges when it comes to breast cancer. Not only are they more likely to be diagnosed with late stage tumors and have poorer prognoses relative to older women, but they are also more likely to experience diagnostic delays. Given the complexity of delays and how they can stem from both the patients themselves as well as the healthcare system, we sought to better understand the barriers and facilitators to a timely diagnosis of breast cancer in young women from the perspectives of primary care and obstetrics/gynecology (OB/GYN) providers who often serve as the first point-of-contact for health issues for female patients. Methods: As part of the Breast Cancer in Young Women: Awareness, Views, Experiences (BRAVE) Study, we conducted one-on-one interviews with four primary care and three OB/GYN physicians, who routinely see young female patients in their California-based practice, to understand their perceptions, approaches, and procedures to diagnosing a young woman with breast cancer. Each interview was recorded, transcribed, coded, and analyzed using NVivo 15, and emergent themes were identified. A survey that included demographic, medical training, and practice-related questions was also administered. Results: The average age of the providers was 47 years with most identifying as Asian American (57%). Four key themes emerged from the interviews. First, there appeared to be a distinction between provider autonomy versus healthcare system constraints with providers in private practice having greater flexibility to deliver more personalized care. Second, we noted how provider-led education could facilitate early detection of breast cancer by reducing stigma surrounding feminine bodily self-awareness. Third, providers acknowledged how there were insurance and financial barriers, which often prevented coverage for diagnostic tests or problem-based visits and left women unable to access needed care. Fourth, it seemed like the diagnostic process was often impacted by providers having to balance screening guidelines with patient anxiety. Conclusions: When it comes to the diagnosis of breast cancer in young women, structural, institutional, and provider-specific factors play critical roles. Providers working in institutions that allow them more clinical autonomy often have the flexibility and time to deviate from standardized guidelines and deliver more personalized care. Clinical autonomy may facilitate timely diagnosis particularly in young women under age 40 whose case may not conform to standardized screening and diagnostic recommendations. Given that a timely diagnosis can be attributed to factors related to patients as well as providers, our study is currently exploring this topic from both perspectives. Focus groups with young breast cancer survivors have already been conducted, and additional interviews with providers are planned.