title: Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis: The Mediating Effects of Health Care Facility Factors.
abstract: BACKGROUND
  Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care.
  
  
  OBJECTIVE
  We examined racial/ethnic disparities in delayed diagnosis for breast cancer in the Breast Cancer Care in Chicago Study and estimated the potential mediating effects of facility factors.
  
  
  METHODS
  Breast cancer patients (N=606) contributed interview and medical record data as part of a population-based study.
  
  
  METHODS
  Race/ethnicity was self-reported at interview. Diagnostic delay was defined as an excess of 60 days between medical presentation and a definitive diagnosis. Facility factors included the facility of medical presentation with respect to: (1) accreditation through the National Consortium of Breast Centers; (2) certification as a Breast Imaging Center of Excellence through the American College of Radiology; and (3) status as a disproportionate share hospital through the state of Illinois as well as the number of facilities used between presentation and diagnosis.
  
  
  RESULTS
  Relative to non-Hispanic whites, minorities were more likely to experience a diagnostic delay, present at a nonaccredited facility and at a disproportionate share hospital, and involve multiple facilities in their diagnosis. Together, facility factors accounted for 43% of the disparity in diagnostic delay (P<0.0001).
  
  
  CONCLUSIONS
  Initial presentation of breast cancer at higher resourced facilities can reduce diagnostic delays. Disparities in delay are partly due to a disproportionate presentation at lower resourced facilities by minorities.
authors.affiliation: *School of Public Health, University of Illinois-Chicago, Chicago; †Fred Hutchinson Cancer Research Center, Seattle, WA ‡Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL.
authors.forename: Yamile
authors.initials: Y
authors.lastname: Molina
authors.forename: Abigail
authors.initials: A
authors.lastname: Silva
authors.forename: Garth H
authors.initials: GH
authors.lastname: Rauscher
mesh_terms: D000068:Accreditation; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D002568:Certification; D002641:Chicago / Q000453:epidemiology; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D044469:Racial Groups; D064876:Safety-net Providers / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D044465:White People