Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women

Abstract

Background The North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides breast cancer screening services to underserved women to mitigate disparities in access to care. The authors sought to characterize this understudied population. Methods Women 21 years old or older who underwent their first breast cancer screen through NC BCCCP from 2008 to 2018 were included. Demographic factors associated with the timeline of care and odds of a breast cancer diagnosis were identified with negative binomial and logistic regression, respectively. Results Of the 88,893 women identified, 45.5% were non‐Hispanic (NH) White, 30.9% were NH Black, 19.6% were Hispanic, 1.7% were American Indian, and 1.1% were Asian. Breast cancer was diagnosed in 2.5% of the women (n = 2255). Hispanic women were the least likely to be diagnosed with breast cancer (odds ratio vs NH White women, 0.40; 95% confidence interval [CI], 0.34‐0.47). Among patients with breast pathology, the median time to diagnosis was 19 days (interquartile range [IQR], 10‐33 days), and the time to treatment was 33 days (IQR, 19‐54 days). After adjustments, a longer time to diagnosis was significantly associated with age (incidence rate ratio [IRR], 1.01; 95% CI, 1.01‐1.02) and being NH Black (vs NH White; IRR, 1.17; 95% CI, 1.06‐1.29). A longer time to treatment was significantly associated with age (IRR, 1.01; 95% CI, 1.01‐1.01), being NH Black (vs NH White; IRR, 1.20; 95% CI, 1.10‐1.31), and being Hispanic (vs NH White; IRR, 1.22; 95% CI, 1.05‐1.41). Conclusions NC BCCCP participants with breast cancer received treatment within approximately 1 month of presentation, and this finding aligns with quality care benchmarks. Nevertheless, racial/ethnic disparities in timeliness of care persist, and this suggests opportunities for improvement. Lay Summary This review of approximately 90,000 participants in a breast cancer screening program for uninsured and underinsured women highlights the importance of safety net programs in providing timely care to underserved patients. The authors found that the North Carolina Breast and Cervical Cancer Control Program met timeliness benchmarks from the Centers for Disease Control and Prevention across all racial/ethnic groups. However, non‐Hispanic Black women experienced relative delays in the time to diagnosis, and both non‐Hispanic Black women and Hispanic women experienced relative delays in the time to treatment. These findings demonstrate how racial/ethnic disparities in the timeliness of care can persist even within a program intended to reduce barriers to access.

Annual report to the nation on the status of cancer, part 1: National cancer statistics

“…The highest breast cancer death rates seen among Black females are partially caused by the significant barriers to providing access to timely, high‐quality medical care, which require addressing multiple dimensions of disparity across the continuum of cancer care. 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 …”

Exploring access to care from the perspective of patients with breast cancer: A qualitative study

“…Waiting for treatment initiation, test results, and referrals were especially trying experiences, and could be even more pronounced in ethnic/racial minorities with limited support and/or resources 38 . Even in a program designed to reduce access barriers, timeliness of care persisted for non‐Hispanic black and Hispanic patients 39 . Patients discussed the roles that family/friends and providers played in helping them deal with negative emotions that usually accompanied the diagnosis/treatment of breast cancer.…”

“… 38 Even in a program designed to reduce access barriers, timeliness of care persisted for non‐Hispanic black and Hispanic patients. 39 Patients discussed the roles that family/friends and providers played in helping them deal with negative emotions that usually accompanied the diagnosis/treatment of breast cancer. Negative emotions of family members, an often‐overlooked aspect of cancer care, was also discussed.…”

Understanding the role of access in Hispanic cancer screening disparities

“…Hispanic and Latinx individuals in the United States experience structural racism across numerous determinants of well‐being and health, including education, housing, employment, and health care 11,12 . This results systematic differences in care access and quality, including for cancer screening 13,14 . Yet, numerous studies have demonstrated a seemingly paradoxical relationship between socioeconomic characteristics and health outcomes in Hispanic populations 15,16 .…”

“…11,12 This results systematic differences in care access and quality, including for cancer screening. 13,14 Yet, numerous studies have demonstrated a seemingly paradoxical relationship between socioeconomic characteristics and health outcomes in Hispanic populations. 15,16 For example, Hispanic individuals are less likely to have health insurance 17 and have, on average, lower incomes and lower educational attainment, 18 which are characteristics associated with lower rates of preventive care and cancer screening use.…”