Diagnosis and Surgical Delays in African American and White Women with Early-Stage Breast Cancer

Abstract

Background: Delays in diagnosis and treatment for breast cancer may contribute to excess deaths among African Americans. We examined racial differences in delays in diagnosis and surgical treatment for early-stage breast cancer and evaluated race-specific predictors associated with delay. Methods: A retrospective cohort study was conducted among 634 African American and white women diagnosed with invasive breast cancer between 2005 and 2010 in New Jersey. Detailed medical-chart abstraction and patient interviews were undertaken. Time intervals were calculated from symptom recognition to diagnosis (diagnosis delay) and from diagnosis to first operation (surgical delay). Binomial regression models were used to examine racial differences in delay and factors associated with ‡ 2 months delay in the overall population and stratified by race. Reasons responsible for diagnosis delay were also examined by race. Results: Compared to white women, African American women experienced significantly higher risk of ‡ 2 months delay in diagnosis and surgical treatment (adjusted relative risks = 1.44 (1.12-1.86) and 3.08 (1.88-5.04), respectively). For the African Americans, predictors of diagnosis delay included mode of detection, insurance, and tumor size; for whites, mode of detection and tumor grade. Surgical delay was associated with operation type and education among African Americans but with operation type and tumor size for whites. Patient-related factors were commonly noted as reasons for diagnosis delay. Conclusions: These findings emphasize the need to raise further awareness, especially among African American patients and their providers, of the importance of prompt evaluation and treatment of breast abnormalities. Research on effective ways to accomplish this is needed.

The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population-Based Study of 3202 Women in Queensland, Australia

“…For symptom-detected breast cancers the outcome variable for DI was >60 days vs. ≤60 days which was selected based on previously published work [28], with the outcome variable for both PI and SI being >30 days vs. ≤30 days. For screen-detected breast cancer, DI delay was defined as >30 days vs. ≤30 days.…”

“…While some recent studies have addressed some of the previously identified weaknesses, such as addressing the psychosocial factors that may predict risk of delay [8,28], others have focused on subgroups (such as young or low income women, early breast cancer only) [23,24,29], or have not included reasons for delay [26,30,31]. It has been suggested that the patient-related interval may be influenced by a number of factors including: “demographic factors” (such as age, education); “psychological factors” (such as fear and anxiety); “social factors” (such as work and family commitments); “behavioural factors” (such as symptom recognition, awareness and watchful waiting); and “system factors” (such as access, difficulties in making appointments, distance to medical services, coordination of diagnostic tests, and inadequate communication between and within medical services) [32].…”

Time from Screening Mammography to Biopsy and from Biopsy to Breast Cancer Treatment among Black and White, Women Medicare Beneficiaries Not Participating in a Health Maintenance Organization

“…Explanations for this phenomenon have identified later stages of cancer at the time of diagnosis (Chatterjee, He, & Keating, 2013; Silber et al, 2013) and poor access to high quality care among Black women (Curtis, Quale, Haggstrom, & Smith-Bindman, 2008; Field et al, 2011; Hunt et al, 2014) as key problems. Specifically, significantly longer time intervals have been observed between abnormal mammogram and treatment initiation for Black women as compared to White women (Ashing-Giwa et al, 2010; Bleicher et al, 2012; George et al, 2015; Gorin et al 2006). In particularly, Gorin et al, (2006) reported that Black women ages 65 years and older were 1.39 times more likely to wait more than 60 days between an abnormal mammogram and a diagnostic biopsy, and 1.64 times more likely to wait more than 30 days for treatment once breast cancer was diagnosed.…”

Race/ethnicity and socio-economic differences in breast cancer surgery outcomes

“…Although Black women are less likely to develop breast cancer compared with Whites, once diagnosed, Black women are less likely to receive guideline-adherent treatment [7][8][9][10] and have significantly lower 5-year survival rates [11][12][13]. These differences may be due to racial differences in tumor biology and disease aggressiveness [14][15][16], socio-economic factors and accessibility of healthcare that limit access to high quality treatment [17][18][19][20], presence of comorbid conditions [9,21,22], and psychosocial factors [23,24] that may influence responses to treatment.…”

“…Variations in cancer treatment and treatment outcomes may partially account for the observed racial and socio-economic disparities in breast cancer mortality [2][3][4][5][6][7][8][9][10][11]. A growing number of studies indicate that African-American women are less likely to undergo breast-conserving surgery (BCS) compared with White women [2,[12][13][14] whereas other studies either reported no difference [15,16] or observed opposite findings [17,18].…”