Submitted to: Women and Health
Publication Type: Peer reviewed journal
Publication Acceptance Date: 8/30/2010
Publication Date: 12/1/2010
Citation: Williams, D.L., Tortu, S., Thomson, J.L. 2010. Factors associated with delays to diagnosis and treatment of breast cancer in women in a Louisiana urban safety net hospital. Women and Health. 50(8):705-718. Interpretive Summary: Breast cancer is the number two cancer killer of women in the United States. While African American women are less likely to get breast cancer, compared to white women, if they do get this cancer, they are more likely to die from it than their white counterparts. The picture is even worse for African American women in Louisiana. While the number of deaths due to breast cancer has been steadily decreasing for Louisiana white women since the early 1990’s, the mortality rate has not changed for African American women in Louisiana. The reasons for these racial differences remain unclear. It may be that African American women in Louisiana are experiencing more delays in diagnosis, and treatment of breast cancer compared to their white counterparts. To explore this idea, we looked at a group of white and African American women diagnosed with breast cancer in a Louisiana public hospital that serves under- and uninsured individuals. Approximately one-third of the women diagnosed with breast cancer experienced diagnosis delays (> 60 days from discovery of initial abnormality to diagnosis of breast cancer). Significantly, more African American women, women with early stage breast cancer, women with smaller tumor sizes, and women whose abnormality was discovered by mammography experienced delays compared to their counterparts. While the finding of racial differences was not surprising, those involving early stage, smaller tumor size, and mammographic finding were unexpected. It may be that these characteristics do not impart the same sense of urgency in diagnosis of breast cancer as do later stage disease, larger tumor sizes, and other findings, such as, a visible mass in the breast. For treatment delays (> 60 days from diagnosis of breast cancer to initiation of treatment), the findings were somewhat different with less (12%) of the women in this study experiencing these type of delays. No racial differences were found in treatment delays, although older women were more likely to experience this type of delay compared to younger women. The results of our study support the idea that poor outcomes in breast cancer observed among Louisiana African American women may be partly attributed to diagnostic delays; however, the same is not true for treatment delays in which no racial differences were found. The fact that racial disparities in breast cancer outcomes in Louisiana exist is indisputable; however, the reasons for these disparities remain unclear and beg for additional research.
Technical Abstract: Only lung cancer surpasses breast cancer as a cause of death from cancer; however, the burden of breast cancer is not borne equally across racial and ethnic groups. In the United States, African American (AA) women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities, and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and AA women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays), and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included; age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more AA women experiencing delays than white women (34% versus 17%, respectively). AA and white women did not differ in distribution of stages of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More AA women experienced delays in diagnosis; however, these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities, as well as other possible barriers to treatment, warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.