Abstract PS3-02-28: Emergency Department Breast Cancer Screening Pilot: Improving Access to Screening and Diagnosis for Underserved Populations

Abstract Objectives: Breast cancer is the most common cancer in women, and those diagnosed with breast cancer early have a 93% higher 5-year survival rate compared to those diagnosed at a later stage. Presently, biennial mammogram screenings are recommended for women 40 yrs or older. In 2022, 67.8% of U.S. women aged 40 or older reported having had a mammogram in the past 2 years. However, mammography rates were lowest among women with no insurance or access to primary care. Emergency departments (EDs), which serve as a safety net for populations with poor access to care, offer a unique opportunity to reach these underserved groups with preventive health services. An urban ED in Chicago piloted an Electronic Health Record (EHR)-driven breast cancer screening initiative targeting females aged 40 years or older to improve access to preventive health services for underserved populations. Through a partnership with Nest Genomics, the program implemented a customized digital navigator, built on the Nest platform, to facilitate rapid breast symptom screening and hereditary cancer risk assessment (HCRA). The initiative used a multi-modal outreach strategy to engage with patients in-person, by phone, and via text and email. Two patient navigators contacted patients identified by the EHR algorithm and offered breast cancer education, the opportunity to complete the Nest symptom screener and HCRA, and linkage to screening mammography. Referrals for breast Magnetic Resonance Imaging (MRI), genetic testing, and/or chemoprevention were provided to qualifying patients. This retrospective quality improvement study evaluated outcomes from this initiative between 4/1/2024 and 6/30/2025. Methods: Descriptive statistics were used to summarize patient characteristics and the primary outcomes, including completion of risk assessment and linkage to mammogram. Results: Between 4/1/2024 and 06/30/2025, 303 patients aged 40 or above (mean age = 51) were reached (45% via phone outreach, 37% via text and email, and 18% via in-person outreach) through the ED Breast Cancer Screening initiative. Of those reached, the majority were Non-Latinx Black (n = 199, 66%) and insured through Medicaid (n = 136, 45%). Screening mammogram orders were placed for 65 patients, 56 screening mammograms were scheduled, and 26 screening mammograms were performed. For half (n = 13, 50%) of the 26 patients completing a screening mammogram, it was their first ever mammogram. Among the 303 patients reached, 63% completed the HCRA (n = 191), 73 patients met national guidelines-based criteria for genetic testing, 13 met criteria for breast chemoprevention, and 11 met criteria for supplemental screening with Breast MRI. During the study period, 11 of 73 patients who met genetic testing criteria were scheduled for a genetic counseling appointment and no patients had yet attended the appointment. Two of the 13 patients eligible for chemoprevention were scheduled with the high-risk clinic, and 1 had attended and received a prescription. Four of the 11 patients eligible for supplemental breast MRI were referred to their PCP and 1 patient had a breast MRI ordered. Conclusions: Our ED initiative identified an underserved patient population that had not yet received recommended breast cancer screening in other venues. EHR-driven screening initiatives that leverage multi-modal outreach strategies and digital patient navigation can improve access to preventive health screenings for vulnerable patients seen in EDs. Further work is needed to address challenges in ensuring timely and effective linkage to recommended follow-up services (e.g. mammography, genetic counseling, high-risk clinic). Citation Format: A. Maheswaran, C. Mauntel-Medici, J. Green, R. Hunt, N. Awati, S. Hay, T. Schmidlen, E. Simmons, M. Snir, J. Lin. Emergency Department Breast Cancer Screening Pilot: Improving Access to Screening and Diagnosis for Underserved Populations abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-02-28.