SGO 2025: The MRI Gap and How Race and Insurance Shape Cervical Cancer Treatment Timelines

Pharmacy Times interviewed Sophie Jabban, a medical student at NYU Grossman School of Medicine, on 2 studies she presented at the Society of Gynecological Oncology (SGO) Annual Meeting in Seattle, Washington. The posters were titled “Disparities in time to MRI by race and ethnicity among individuals receiving chemoradiation for treatment of cervical cancer” and “Disparities in MRI Access by Insurance Among Cervical Cancer Patients Receiving Chemoradiation.”

Sophie Jabban is a medical student at NYU Grossman School of Medicine in New York, New York.

In “Disparities in time to MRI by race and ethnicity among individuals receiving chemoradiation for treatment of cervical cancer,” Jabban discussed significant racial and ethnic disparities in the time to MRI among patients receiving chemoradiation for cervical cancer. Specifically, Black/African American and Hispanic/Latine patients experienced nearly twice the wait time for MRI compared to White patients. While part of this disparity is attributable to greater reliance on public insurance and treatment in public hospitals—where MRI resources are often more limited—the researchers also found delays persisted for Black/African American patients even within private hospital systems. This suggests that factors beyond resource availability, such as systemic and structural barriers, are contributing to the delays.

One major clinical consequence of delayed MRI access is a corresponding delay in the initiation of treatment. Although not all patients undergoing chemoradiation receive MRI, it remains a critical tool for radiation oncologists in designing precise treatment plans. As a result, limited MRI access due to scheduling issues, insurance hurdles, or institutional bottlenecks can slow treatment planning and ultimately delay therapy. These challenges disproportionately affect racial and ethnic minorities, potentially compounding existing disparities in cancer care and outcomes.

Several systemic barriers were identified as contributing to the disparities. Access to primary and routine health care plays a key role. Patients with consistent access to gynecologic follow-up, often White patients in this study, were typically diagnosed earlier through routine screenings like Pap smears and were more easily referred to oncology care through established networks. In contrast, many non-White patients were diagnosed after presenting to emergency departments (EDs) with symptomatic disease, resulting in delays in both diagnosis and care initiation due to a lack of continuity and follow-up.

Insurance status also played a significant role. Patients with Medicaid, or those who only obtained emergency Medicaid after diagnosis, experienced longer delays in receiving imaging and beginning treatment. This was due to additional administrative steps or slower approval processes commonly associated with public insurance. The research team plans to explore these systemic factors further, particularly how differences in care pathways and insurance processes contribute to disparities in MRI access and overall cancer care.

In “Disparities in MRI Access by Insurance Among Cervical Cancer Patients Receiving Chemoradiation,” Jabban discussed how insurance status affects access to MRI among patients with cervical cancer undergoing chemoradiation. Findings revealed a statistically significant delay in time to MRI for patients with Medicaid compared to those with private insurance. This disparity may be due to multiple factors, including the fact that some patients only acquired emergency Medicaid following their diagnosis. Interestingly, patients with Medicare experienced MRI access timelines similar to those with private insurance.

While the clinical consequences of these delays are still under investigation, early findings suggest that delayed MRI may impact treatment planning. To address these disparities, the interviewee recommends policy or institutional changes such as providing more clinical support to help patients obtain insurance coverage for necessary imaging and collaborating with radiation oncologists to explore alternative imaging options, like computed tomography (CT), which may be more accessible for underinsured patients.

Disparities in time to MRI by race and ethnicity among individuals receiving chemoradiation for treatment of cervical cancer

Pharmacy Times: How do racial and ethnic disparities affect the time to MRI for patients with cervical cancer receiving chemoradiation?

Patient undergoes MRI. Image Credit: © ihorvsn - stock.adobe.com

Sophie Jabban: We found that Black/African American patients and Hispanic/Latin patients waited almost twice as long as White patients to get an MRI after being diagnosed with cervical cancer. This is likely multifactorial, as more non-White patients use public insurance and were treated at the public hospital, where certain resources (such as MRI) are not as readily available. Still, our group actually found that among patients treated in the private hospital system, there was still a delay to MRI for Black/African American patients compared to White patients, indicating there are additional factors at play. We plan to further assess the paths through which patients are receiving their diagnoses (for example, upon presentation to the ED vs through a routine office visit), which may influence these differences in time to MRI.

Pharmacy Times: What are the potential clinical consequences of delayed MRI access on treatment planning and outcomes among different racial and ethnic groups?

Jabban: One of the most significant consequences is a delay in the initiation of treatment. While not all patients receiving chemoradiation undergo MRI, this imaging modality is highly valuable for radiation oncologists in designing precise treatment plans. In practice, most patients do receive an MRI prior to starting chemoradiation. Therefore, limited access to MRI—whether due to systemic barriers, availability, or scheduling issues—can lead to delays in treatment planning and ultimately in starting therapy. This issue disproportionately affects certain racial and ethnic groups who already face barriers within the health care system, potentially exacerbating existing disparities in cancer outcomes.

Pharmacy Times: What roles do systemic barriers (eg, insurance coverage, geographic location, referral processes) play in racial and ethnic disparities in MRI access?

Jabban: As noted above, there are numerous systemic barriers playing a role here, many of which we hope to further research to understand the most significant drivers behind disparities in the overall cancer care journey.

Access to primary / routine healthcare is a large systemic barrier. For many of the patients in our study with greater healthcare access, which involved a larger percentage of white patients, their cancers were frequently diagnosed through consistent Gyn follow-up and via pap smears - these patients relied on strong referral networks from their primary care providers to quickly access oncologists and initiate treatment. This differs from other patients who access their healthcare through ED visits. For these patients, initial presentation involved presenting to the ED for symptomatic malignancy (abnormal bleeding, pelvic pain)—these patients had both a delay to diagnosis and then a delay to accessing care because they were more easily lost to follow up after diagnosis and were less readily referred to oncology.

Access to insurance is also a key barrier. For many patients with Medicaid, we noticed longer timelines to chemoradiation compared to those who had private insurance. These patients either had no insurance prior to cancer diagnosis and required emergency Medicaid, adding an extra step to their treatment journeys, or Medicaid itself is associated with longer times to approval for imaging or treatment. This is something we hope to further investigate.

Disparities in MRI Access by Insurance Among Cervical Cancer Patients Receiving Chemoradiation

Pharmacy Times: How does insurance status impact access to MRI for patients with cervical cancer undergoing chemoradiation?

Jabban: We found that there is a statistically significant difference in time to MRI for patients with Medicaid as primary insurance vs private insurance. This could be multifactorial, as some of these patients accessed emergency Medicaid after diagnosis, so we still need to parse out whether the insurance itself is a hindrance to treatment. Overall, Medicare patients were receiving MRIs on similar timelines as privately insured patients.

Pharmacy Times: What are the clinical consequences of delayed or limited MRI access on treatment planning and outcomes in cervical cancer care?

Jabban: This is an important question that we are still looking to answer with future analyses.

Pharmacy Times: What policy or institutional changes could improve MRI access for underinsured or uninsured patients with cervical cancer?

Jabban: We are further assessing the underlying causes that led some groups to have delays to MRI. However, based on our initial results, additional clinical support to aid in obtaining insurance coverage for indicated tests, such as MRI, may be of benefit. In addition, collaboration with radiation oncology to determine if radiation planning based on imaging that may be more readily accessed, such as CT, is feasible.