Disparities in Breast Cancer Surgery Delay: The Lingering Effect of Race
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Delays to surgical breast cancer treatment of 90 days or more may be associated with greater stage migration. We investigated racial disparities in time to receiving first surgical treatment in breast cancer patients.
Insured black (56 %) and white (44 %) women with primary breast cancer completed telephone interviews regarding psychosocial (e.g., self-efficacy) and health care factors (e.g., communication). Clinical data were extracted from medical charts. Time to surgery was measured as the days between diagnosis and definitive surgical treatment. We also examined delays of more than 90 days. Unadjusted hazard ratios (HRs) examined univariate relationships between delay outcomes and covariates. Cox proportional hazard models were used for multivariate analyses.
Mean time to surgery was higher in blacks (mean 47 days) than whites (mean 33 days; p = .001). Black women were less likely to receive therapy before 90 days compared to white women after adjustment for covariates (HR .58; 95 % confidence interval .44, .78). Health care process factors were nonsignificant in multivariate models. Women with shorter delay reported Internet use (vs. not) and underwent breast-conserving surgery (vs. mastectomy) (p < .01).
Prolonged delays to definitive breast cancer surgery persist among black women. Because the 90-day interval has been associated with poorer outcomes, interventions to address delay are needed.
KeywordsBreast Cancer Human Epidermal Growth Factor Receptor Black Woman Patient Navigation Breast Cancer Outcome
Supported in part by grants from the American Cancer Society (Sheppard: PI MRSGT-06-132 CPPB), Komen for the Cure Inc. (PI: Sheppard POP0503398), and the National Cancer Institute (Mandelblatt: RO1 CA124924, RO1 CA 127617, and KO5 CA96940). We thank all the research, support, and clinical staff members who helped recruit women. We also acknowledge the support of Becky Montalvo and the Love/Avon Army of Women, including Dr. Susan Love and Leah Wilcox.
The authors declare no conflict of interest.
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