title: Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study.
abstract: Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities. As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care system.
authors.affiliation: Institute for Health Promotion Research, Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, TX USA ; The National Latino Cancer Research Network, Institute for Health Promotion Research, Cancer Therapy & Research Center, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1000, San Antonio, TX 78230 USA.
authors.forename: Amelie G
authors.initials: AG
authors.lastname: Ramirez
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Pérez-Stable
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Talavera
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Penedo
authors.forename: J Emilio
authors.initials: JE
authors.lastname: Carrillo
authors.forename: Maria E
authors.initials: ME
authors.lastname: Fernandez
authors.forename: Edgar
authors.initials: E
authors.lastname: Muñoz
authors.forename: Dorothy
authors.initials: D
authors.lastname: Long Parma
authors.forename: Alan Ec
authors.initials: AE
authors.lastname: Holden
authors.forename: Sandra
authors.initials: S
authors.lastname: San Miguel de Majors
authors.forename: Anna
authors.initials: A
authors.lastname: Nápoles
authors.forename: Sheila F
authors.initials: SF
authors.lastname: Castañeda
authors.forename: Kipling J
authors.initials: KJ
authors.lastname: Gallion
keywords: Breast cancer screening; Definitive diagnosis; Health disparities; Latinas; Six cities study