“…Given an insured population, system inefficiencies, including busy clinics, have been implicated in differences in delay by ethnic/racial groups. 10,36,37 Cultural variations in approaches to cancer detection and follow-up for abnormal findings, including levels of acculturation, or attitudes and beliefs toward cancer causation, preferences in cancer detection, or the perceived effectiveness of treatment may influence the timeliness of services. 38 Although these predictors, too, were unmeasured in this study, patient psychosocial fac- tors, such as fear and anxiety, a sense of fatalism, perceived risk, misunderstanding, body image, the competing demands of caring for others, and social norms, may also delay diagnostic evaluation and treatment.…”