Impact of Race, Ethnicity, Preferred Language, and Insurance Status on Time to Treatment and Treatment Delay Among Women with Breast Cancer at an Academic, Safety-Net Hospital

Ethnoracial Disparities in Breast Cancer Treatment Time and Survival: A Systematic Review With a DAG-based Causal Model

“…Future research must adopt a more inclusive and multi-level approach, incorporating systemic and societal factors alongside individual-level determinants to advance our understanding and improve interventions in breast cancer care. Unmeasured factors Hershman et al, 2005 [19] Performance status, socioeconomic status, and obesity Alderman et al, 2010 [30] Surgical complications, survival/recurrence, low-volume vs. high-volume clinic setting Chandwani et al, 2014 [31] Additional test to investigate preoperative magnetic resonance imaging Sheppared et al, 2015 [32] Stage migration of disease Buckley et al, 2017 [34] Type of reconstruction Jabo et al, 2018 [51] Social support, not seeking care as instructed, comorbidity, human epidermal growth factor receptor 2 (HER2) status, insurance barrier or operating room availability, physician driven such as overbooked clinics, preoperative imaging/testing Larson et al, 2018 [54] Zip code, type of hospital, specific chemotherapy Eaglehouse et al, 2019 [37] Erythroblastic oncogene B (ERBB2) status Kupstas et al, 2019 [50] Specific chemotherapy regimen, length of treatment, completion of chemotherapy, recurrence Emerson et al, 2020 [26] Distance to care, type of care center, workload associated with treatment. Specific financial and transportation issues, biological factors, facility information Prakash et al, 2021 [46] Disease specific survival, recurrence Jackson et al, 2021 [41] Genetic information Dankwa-Mullan et al, 2021 [42] No pathology variables, patients preferred surgery type, no data on health insurance Blazek et al, 2021 [52] Hormone receptor status Chagpar et al, 2022 [43] Patient co-morbidities, insurance status, education, income, insurance, and health literacy Navarro et al, 2022 [44] Family history of breast cancer, breast cancer type, patient's nativity and immigration status Schermerhorn et al, 2022 [27] Individual level income, individual level education, individual experience of discrimination Sukniam et al, 2022 [29] Quality of life, recurrence free survival, progression free survival Chen et al, 2023 [2] Patient-level SES, individual level income, additional imaging, and multiple provider consultation Fwelo et al, 2023 [5] Details of chemotherapy versus surgery Beaulieu-Jones et al, 2024 [1] Housing insecurity, comorbid mental health conditions, food insecurity, access to transportation, and proximity to the health system, barriers to breast cancer screening and/or diagnosis…”

“…Of the 36 studies, 12 indicated that examining disparity was a primary objective. Studies categorized ethnoracial groups in a variety of ways, mainly to support comparing Black and White populations [19,[25][26][27][28][29][30][31]. Several studies also incorporated Hispanic and non-Hispanic ethnicity [32,33].…”

“…Five studies focused on time to initiation of any type of treatment in breast cancer patients [25][26][27][28][29][30]. Studies on time to first treatment found higher risk of delay in Black, Hispanic or other nonwhite races/ethnicities compared to White patients [25][26][27].…”