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Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Black women are more likely to die of breast cancer than White women. This study evaluated the contribution of time to primary surgical management and surgical facility characteristics to racial disparities in breast cancer mortality among both Black and White women.

Methods

The study identified 2224 Black and 3787 White women with a diagnosis with stages I to III breast cancer (2010–2014). Outcomes included time to surgical treatment (> 30 days from diagnosis) and breast cancer mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) associating surgical facility characteristics with surgical delay were computed, and Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% CIs associating delay and facility characteristics with breast cancer mortality.

Results

Black women were two times more likely to have a surgical delay (OR, 2.15; 95% CI, 1.92–2.41) than White women. Racial disparity in surgical delay was least pronounced among women treated at a non-profit facility (OR, 1.95; 95% CI, 1.70–2.25). The estimated mortality rate for Black women was two times that for White women (HR, 2.00; 95% CI, 1.83–2.46). Racial disparities in breast cancer mortality were least pronounced among women who experienced no surgical delay (HR, 1.81; 95% CI, 1.28–2.56), received surgery at a government facility (HR, 1.31; 95% CI, 0.76–2.27), or underwent treatment at a Commission on Cancer-accredited facility (HR, 1.82; 95% CI, 1.38–2.40).

Conclusions

Black women were more likely to experience a surgical delay and breast cancer death. Persistent racial disparities in breast cancer mortality were observed across facility characteristics except for government facilities.

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Acknowledgments

This this work was supported in part by the Cancer Prevention and Control Research program; the Winship Research Informatics shared resources, a core supported by the Winship Cancer Institute of Emory University; and the Komen Foundation (CCR19608510) awarded to Lauren E McCullough. Lindsay J. Collin was supported by TL1TR002540 from the National Center for Advancing Translational Sciences of the National Institutes of Health. Jasmine M. Miller-Kleinhenz was supported NIH/NIGMS (2K12GM000680). The collection of cancer incidence data used in this study was supported by contract HHSN261201800003I, Task Order HHSN26100001 from the NCI and cooperative agreement 5NU58DP003875-04 from the U.S. Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Lindsay J. Collin PhD

  2. Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

    Katie Ross-Driscoll PhD & Preeti D. Subhedar MD

  3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Rebecca Nash MPH, Jasmine M. Miller-Kleinhenz PhD, Leah Moubadder MPH, Catherine Osborn MPH, Kevin C. Ward PhD & Lauren E. McCullough PhD

  4. Emory University, Atlanta, GA, USA

    Sheryl G. A. Gabram-Mendola MD

  5. Georgia Center for Oncology Research and Education, Atlanta, GA, USA

    Sheryl G. A. Gabram-Mendola MD

  6. Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Jeffrey M. Switchenko PhD

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  1. Lindsay J. Collin PhD
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Correspondence to Lindsay J. Collin PhD.

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Collin, L.J., Ross-Driscoll, K., Nash, R. et al. Time to Surgical Treatment and Facility Characteristics as Potential Drivers of Racial Disparities in Breast Cancer Mortality. Ann Surg Oncol 29, 4728–4738 (2022). https://doi.org/10.1245/s10434-022-11720-z

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