Racial and ethnic disparities in breast cancer care: Barriers associated with treatment delays.

Abstract

e12706 Background: Breast cancer is one of the most common cancers among women. Yet, disparities in access to a timely diagnosis and treatment persist for racial and ethnic minority groups. These disparities may be explained by socioeconomic factors such as poverty, limited education, or lack of insurance. Current national breast cancer guidelines suggest diagnosis should happen within 60 days of an abnormal screening. Treatment delays longer than 90 days are linked to lower survival rates. Previous research has shown that Black and Hispanic women face longer time to treatment, regardless of their cancer stage or insurance coverage. For this reason, uncovering factors that may lead to treatment delays is crucial to create equitable care. This study aims to identify which factors contribute to treatment delays in women with breast cancer at an urban academic center. Methods: Participants completed a survey to assess unmet needs and perceived barriers during their treatment journey. Retrospective review of medical charts quantified number of days at 3 time points: abnormal mammogram to biopsy, from biopsy to first oncology or surgery visit, and from biopsy to start of first treatment received. Data collected from medical charts included race or ethnicity, primary language, insurance status, tumor stage, and type of treatment received. Results: A total of 53 surveys were analyzed, 34.0% were Latina (n = 18), 39.6% White (n = 21), 22.6% Black (n = 12), and 3.8% Asian (n = 2). Average time from mammogram to biopsy for Latinas was 46.7 days (95% CI 30.8-62.7), White 41.7 days (95% CI 16.9-66.5), Black (55.9 days (95% CI 24.1-87.7). Average time from biopsy to first mammogram appointment for everyone was 17 days (95% CI 12.8-22.7). Average time from biopsy to first treatment received for Latinas was 59.7 days (95% CI 43-76.5), White was 46 days (95% CI 39.9-52.1), Black 49.2 days (95% CI 38.5-59.8). Latino patients were more likely to receive chemotherapy compared to white individuals. Average time to treatment for chemotherapy was at 78 days compared to 26 days for White patients. A composite barrier index demonstrated that 66.7% of Latina participants reported at least 1 barrier, compared with 22.9% of non-Latina participants. This included feeling depressed, anxiety, and fear of an unfavorable outcome. Income demonstrated an association with treatment delay (Spearman ρ = –0.20, p = 0.16). Conclusions: Treatment delays start before the first visit in scheduling diagnostic mammograms and initial biopsy. Latina women showed greater treatment delay at time of starting first treatment. Moreover, they report higher levels of anxiety, depression, and fear of an unfavorable outcome along with increased financial concerns. Treatment delay barriers persist despite no problem understanding their treatment, highlighting the role of structural, socioeconomic, and psychological stressors as a possible cause of treatment delays.