Implications of Physical Access Barriers for Breast Cancer Diagnosis and Treatment in Women With Mobility Disability

Abstract

Although it has been more than 30 years since enactment of the Americans with Disabilities Act, people with disabilities continue to face physical access barriers, notably inaccessible medical diagnostic equipment, in clinical settings. Access barriers affect breast cancer screening and treatment for women with disabilities. We used standard diagnosis codes and natural language processing to screen electronic health records (EHRs) in a digital data repository from a large health care delivery system for patients with a pre-existing mobility disability who had been diagnosed with breast cancer between 2005 and 2017. We reviewed EHRs of 20 patients, using conventional content analysis to examine breast cancer diagnosis and treatment experiences. Clinicians noted challenges positioning patients for routine procedures, including manual breast exam, screening mammography, and breast biopsies. Given challenges accommodating disability for adjuvant therapies, mastectomy was favored over breast-conserving options despite early stages of diagnosis. Notations contained little information about proactive problem-solving for arranging accommodations. Notations described physical access barriers for breast cancer detection and treatment, with limited planning for mitigating barriers. Despite 2017 promulgation of federal Standards for Accessible Medical Diagnostic Equipment, implementing these standards requires further rulemaking.