Miller-Kleinhenz 2021


Year: 2021

Title: Racial Disparities in Diagnostic Delay Among Women With Breast Cancer

Country: United States

Age: Adult Only

Sex: Female

Population: Black

Care Setting: Outpatient Ambulatory and Primary Care

Clinical Setting: Breast Cancer Screening

Data Level: Single Institution

Data Type: Disease Registry

Data Source: Georgia Cancer Registry

Conclusion: Disparities In All Minority Groups

Health OutComes Reported: Yes

Mitigation: No

Free Text Conclusion: Black women were more likely to have delay in diagnostic evaluation, biopsy delays, and total delays. Total delay in diagnosis was associated with an increase in BC mortality.

Abstract: PURPOSE: Early diagnosis is fundamental to reducing breast cancer (BC) mortality, and understanding potential barriers from initial screening to confirmed diagnosis is essential. The aim of this study was to evaluate patient characteristics that contribute to delay in diagnosis of screen-detected cancers and the contribution of delay to tumor characteristics and BC mortality. METHODS: Three hundred sixty-two White and 368 Black women were identified who were screened and received subsequent BC diagnoses within Emory Healthcare, a part of Emory University health care system (2010-2014). Multivariable-adjusted logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associating patient characteristics with delay to diagnostic evaluation (30 versus <30 days), delay to biopsy (15 versus <15 days), and total delay (45 versus <45 days). Additionally, the ORs and 95% CIs associating delay with tumor characteristics and BC mortality were computed. RESULTS: Black women and women diagnosed at later stages, with larger tumor sizes, and with triple-negative tumors were more likely to experience 45 days to diagnosis. In multivariable-adjusted models, Black women had at least a two-fold increase in the odds of delay to diagnostic evaluation (OR, 1.98; 95% CI, 1.45-2.71), biopsy delays (OR, 2.41; 95% CI, 1.67-3.41), and total delays 45 days (OR, 2.22; 95% CI, 1.63-3.02) compared with White women. A 1.6-fold increased odds of BC mortality was observed among women who experienced total delays 45 days compared with women without delays in diagnosis (OR, 1.57, 95% CI, 0.96-2.58). CONCLUSION: The study demonstrated racial disparities in delays in the diagnostic process for screen-detected malignancies. Total delay in diagnosis was associated with an increase in BC mortality.