Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management.


The purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.





Published Version (Please cite this version)


Publication Info

Devi, Gayathri R, Laura J Fish, Alexandra Bennion, Gregory E Sawin, Sarah M Weaver, Katherine Reddy, Rashmi Saincher, Anh N Tran, et al. (2023). Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management. Preventive medicine reports, 36. p. 102519. 10.1016/j.pmedr.2023.102519 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Gayathri R. Devi

Professor in Surgery

Dr. Devi’s research interests include functional genomics, anti-cancer drug discovery and development, mechanisms of cancer cell signaling, tumor immunity and applications thereof for overcoming therapeutic resistance in cancer.

The lab has established prostate, inflammatory breast cancer and ovarian cellular and tumor models.


Laura Jane Fish

Assistant Professor in Family Medicine and Community Health

Gregory Eshleman Sawin

Associate Professor in Family Medicine and Community Health

My work is a reflection of a core value in social justice and a passion to increase health equity. Most of my academic career has been as an educator, serving as a family medicine residency director for 10 years prior to joining Duke. Having started my career in Massachusetts, where universal coverage started in 2007, I have had a focus in primary care transformation and value based care, with special attention to doing so in residency clinics. I’m eager to use my position as Vice Chair for Education and Faculty Development in the Department of Family Medicine and Community Health to coordinate efforts across its five divisions and growing research group to build “learning systems” that adopt continuous improvement culture in all that we do.

Research interests: health equity, team based care, primary care transformation, leadership and improvement science and group based opioid treatment.


Anh Nhat Tran

Associate Professor in Family Medicine and Community Health

Minority health inequities
Cross-cultural health interventions
Community based participatory research (CBPR) methods
Cancer health disparities
Sexual health promotion
Lay health advisor (LHA) interventions
Patient-provider interaction
Health inequities 
Social determinants of health     
Clinical leadership training
Community engagement

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