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Original Investigation
November 13, 2006

Delays in Breast Cancer Diagnosis and Treatment by Racial/Ethnic Group

Author Affiliations

Author Affiliations: Department of Health and Behavior Studies, Columbia University (Dr Gorin); Departments of Epidemiology (Dr Gorin) and Biostatistics (Dr Cheng), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center (Drs Gorin and Smith); Department of Radiology, Columbia University Medical Center, New York Presbyterian Hospital (Dr Smith), New York, NY; and Gene-Environment Epidemiology Group, International Agency for Research on Cancer, Lyon, France (Dr Heck).

Arch Intern Med. 2006;166(20):2244-2252. doi:10.1001/archinte.166.20.2244

Background  Although white women have the highest incidence of breast cancer, African American, followed by Hispanic, American Indian/Alaskan Native, and Asian American or Pacific Islander, women have higher death rates from the disease. Timely initiation of treatment has been shown to improve survival, and may help to lessen the mortality differences among racial/ethnic groups.

Methods  The purpose of this study was to describe time delays in the initial diagnosis and treatment of primary breast carcinoma across diverse ethnic/racial groups. Data are from the Surveillance, Epidemiology, and End Results–Medicare database. Women in this study were diagnosed as having breast cancer between January 1, 1992, and December 31, 1999. Billing claims from outpatient and inpatient visits were used. A total of 49 865 female Medicare recipients 65 years and older were enrolled in the study. Racial/ethnic groups were compared in their diagnostic, treatment, and clinical delay (ie, women with a diagnostic and treatment delay).

Results  African American women experienced the greatest diagnostic, treatment, and clinical delay. After controlling for other predictors, compared with white women, African American women had a 1.39-fold odds (95% confidence interval, 1.18-1.63) of diagnostic delay beyond 2 months, a 1.64-fold odds (95% confidence interval, 1.40-1.91) of treatment delay beyond 1 month, and a 2.24-fold odds (95% confidence interval, 1.75-2.86) of having a combined clinical delay.

Conclusions  In a population-based study, African American women experienced the most delays in initial diagnosis and initiation of breast cancer treatment, relative to women of other racial/ethnic subgroups. Despite the limitations of a claims database, the magnitude and direction of the findings are consistent across the research, suggesting the critical importance of reducing these delays.