title: Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors.
abstract: BACKGROUND
  Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays.
  
  
  METHODS
  Population-based sampling and a cross-sectional design were used to recruit 1377 survivors (breast cancer, n = 698; cervical cancer, n = 679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors.
  
  
  RESULTS
  Latina Americans were more likely to report diagnostic delays (P = .003), whereas African Americans were more likely to report therapeutic delays (P = .007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P = .004) and therapeutic delays (P = .000) compared with breast cancer survivors. "Fear of finding cancer" was the most frequently cited reason for diagnostic delays, and "medical reasons" were most frequently cited for therapeutic delays.
  
  
  CONCLUSIONS
  Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays.
authors.affiliation: CCARE, Division of Population Sciences, City of Hope Medical Center, Duarte, California, USA. Kashing@coh.org
authors.forename: Kimlin T
authors.initials: KT
authors.lastname: Ashing-Giwa
authors.forename: Patricia
authors.initials: P
authors.lastname: Gonzalez
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Lim
authors.forename: Cathie
authors.initials: C
authors.lastname: Chung
authors.forename: Benjamin
authors.initials: B
authors.lastname: Paz
authors.forename: George
authors.initials: G
authors.lastname: Somlo
authors.forename: Mark T
authors.initials: MT
authors.lastname: Wakabayashi
mesh_terms: D001741:Black or African American / Q000523:psychology; D000368:Aged; D001213:Asian / Q000523:psychology; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D057210:Delayed Diagnosis / Q000523:psychology*; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D017741:Survivors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D044465:White People / Q000523:psychology