e18510 Background: It is well established that insurance coverage is strongly related to better health outcomes, however there has been little research comparing health care disparity between public vs privatehealth insurance. The aim of our research is to identify differences in treatment in patients with lobular carcinoma in situ (LCIS) based on insurance payer seen at our academic center in Southern New Jersey. Additional analysis included time from diagnosis to treatment and common reasons treatment was not obtained. Our goal is to provide further information on health care disparities between insurance payers and identify areas for improvement. Methods: We conducted a retrospective chart review of 292 patients with LCIS who were seen at the MD Anderson Cancer Center at Cooper in Camden, Voorhees and Willingboro, New Jersey from 2009 to 2019. We stratified the patient population by insurance payer; specifically Medicare, Medicaid and private insurance. We compared treatment outcomes between these three groups using chi square and Kruskall Wallis testing. Results: There was no significant difference in treatment outcome or time to treatment between insurance payers. The majority of patients in each insurance payer group did receive appropriate treatment with either chemoprevention or prophylactic mastectomy. Among those patients who did not receive risk reduction therapy, 22.2% of patients with Medicaid did not see a Medical Oncologist and therefore were not offered chemoprevention. In comparison, only 16.7% of patients with private insurers did not see a Medical Oncologist. Although not statistically significant, this supports prior studies suggesting a disparity in outpatient follow up for patients with Medicaid. Patients with Medicaid had the longest median time from diagnosis to initiation of chemoprevention as compared to patients with Medicare or private insurance. It was notable that among patients who underwent prophylactic bilateral mastectomy, those with Medicaid had the shortest observed time to surgery than patients with private insurance. The reasoning for more expedited times to prophylactic mastectomy than to chemoprevention in our study is unclear. Possible factors include patient perception of bilateral mastectomy being a “definitive” one time procedure eliminating the need for future screening and anxiety related to suspicious findings. Other causes may include the concern for adverse side effects of chemoprevention or patient decision to pursue surgery prior to Medical Oncology follow up. Conclusions: There was no significant difference in treatment outcomes for patients with LCIS based on insurance payer. This is a reassuring finding that provides evidence of appropriate care regardless of insurance payer. In the future, we hope to stratify this data by race and zip code to further assess health care disparities in our patient population in order to provide improvement in their care.

TPS1129 Background: Women of color (WOC) with breast cancer miss and fail key points in care due to racial disparities in cancer services. Conscious and unconscious bias means that these women are not treated in a timely way or as rigorously. They are offered fewer options, and the patient navigation and education needed for them to self-advocate is ignored. Black women in particular have the highest breast cancer death rates. Care delivery differs even independent of such variables as literacy, income, and education. Separately and incrementally, findings to date have shown the potential oof patient navigation, equity assessment, and mobile support to reverse these disparities. In pilot investigations –– partnering with academic cancer centers –– The Chrysalis Initiative (a nonprofit patient advocacy and research organization) has validated the potential of combining these approaches in a three-part intervention. Based on preliminary work, it is hypothesized patients will: experience significantly greater adherence to the recommended continuum of care, without disruption or barriers; more often seek second opinions and additional supportive resources, and engage in clinical trials; demonstrate less co-morbidities, through more preventive measures and healthful lifestyle; suffer fewer interactions perceived to be influenced by racism; undergo less financial distress, with guidance on managing and planning costs; feel more confident and more optimistic in their outlook; and achieve better clinical results and lower costs. Methods: To determine and document the full impact, both quantitatively and qualitatively, of the experimental three-part intervention, the trial is: delivering navigation/coaching services to the study population, using counselors who are predominantly WOC who have experienced the challenges of breast cancer care. Surveys and interviews pre- and post-intervention will add to impact measures; providing the experimental group with the BC Navi App on both iOS and Android devices . Developed in partnership with InTouch, the app supports engagement and tracking. It provides a dashboard for care evaluation to supplement EMR data; conducting an equity assessment of breast cancer services of partnering clinical programs through use of focus groups with staff, patients, and community; procedural checks; and data collection from center EHR systems. The review audits 40 domains of care based on NCCI, NCI, ASCO, ACR, and other standards. The assessment team works closely and collaboratively with each cancer center’s clinical and administrative staff to reveal disparities and find consensus on ways to close gaps. This trial in progress is randomizing 200 subjects to the coaching/mobile app intervention arm and 100 to benefits of the equity assessment only, with comparison to nonWOC with breast cancer. The trial aims to disseminate the three-part intervention in easily reproducible form.