title: Factors associated with delays to diagnosis and treatment of breast cancer in women in a Louisiana urban safety net hospital.
abstract: Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American 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 African American 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 African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage 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 African American 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.
authors.affiliation: Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana 70112, USA. DWilli3@lsuhsc.edu
authors.forename: Donna L
authors.initials: DL
authors.lastname: Williams
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tortu
authors.forename: Jessica
authors.initials: J
authors.lastname: Thomson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008145:Louisiana / Q000453:epidemiology; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data*