Abstract Background: Inflammatory Breast Cancer (IBC) and other rare, aggressive breast cancer subtypes disproportionately impact younger women and is often misdiagnosed or diagnosed at later stages due to atypical presentation, limited awareness, and lower detection rate on screening mammograms While IBC incidence is low at around 2%, it accounts for up to 10% of all breast cancer deaths. Further, racial disparities in IBC incidence are extensively documented, with literature documenting black women as having significantly higher rates than white patients. Primary care providers (PCPs) are generally the first point of contact for patients, making their ability to recognize IBC critical. However, diagnostic decisions can be influenced by cognitive shortcuts and system-level constraints, which may contribute to delayed recognition. Given known urban-rural disparities of health care access and outcomes for various conditions, this study examined whether PCP awareness and confidence in diagnosing IBC differ by practice setting in North Carolina (NC). Methods: The PCPs recruited in this survey included physicians, nurse practitioners or certified nurse midwives and physician assistants, and majority practiced family medicine. Rural PCPs (N=30) and urban PCPs (N=78) within NC were recruited through institutional patient portals via convenience sampling to complete an online, structured survey that included confidence scales and open-ended questions. Survey items assessed participant demographics, IBC awareness, confidence levels, and recognition of 18 IBC-specific knowledge items (11 symptoms, 7 risk factors). Quantitative data was analyzed using descriptive statistics and bivariate comparisons to identify similarities and differences between rural and urban PCP responses. Results: Only 63% (19/30) of rural PCPs and 59% (46/78) of urban PCPs had heard of IBC prior to the survey (p = 0.85), highlighting a similar limited lack of awareness surrounding IBC regardless of practicing setting. Likewise, rural and urban PCPs reported similar levels of confidence on their ability to detect IBC. The mean confidence score (0-7 scale) was similar among rural and urban PCPs (3.39 vs 3.35), highlighting a low to moderate confidence in recognizing IBC. A chi-squared test of independence found no statistically significant difference in distribution of confidence ratings between rural and urban PCPs (χ2 = 4.65, df = 6, p = 0.59). Urban and rural PCPs demonstrated high recognition rates of 9 clinically characteristic IBC symptoms, with statistically similar rates for 8 of the 9 symptoms: breast swelling, peau d’orange, breast tenderness/pain/itching, redness, skin thickening, nipple discharge, inverted nipple, palpable breast mass (all p 0.05). Rural PCPs were significantly more likely than urban PCPs to recognize lymph node change as a symptom of IBC (90.0% vs. 69.2%, χ2 = 6.75, p = 0.0094). When asked about initial follow-up steps for a hypothetical case of IBC, most rural (25/30; 83%) and urban PCPs (59/78; 75.6%) indicated they would refer for breast imaging (i.e. mammogram or ultrasound) after a failed course of antibiotics. A majority expressed interest in additional training to better diagnose and care for patients with IBC, with online CME being the preferred format (rural 22/30, 73.3%; urban 44/78, 56.4%). Conclusion: Awareness and confidence in diagnosing IBC remain limited among PCPs across of practice setting, suggesting that challenges extend beyond geography and reflect broader systemic gaps. These preliminary findings highlight an urgent need and demand for scalable, evidence-based strategies – such as targeted education and decision support tools-- to strengthen early recognition and reduce delays in care for patients with IBC. Citation Format: T. Tan, A. Bennion, MS, K. Lebron, J. Barbour, G. Devi, A. N. Tran. Systemic knowledge gaps in IBC recognition: a barrier to timely diagnosis and care 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 PS2-13-15.
Tan et al. (Tue,) studied this question.