The findings suggest that both high-risk patients and high-risk regions should be considered in clinical and policy strategies to facilitate timely breast cancer care.
Both race and geographic region were significantly associated with delays in breast cancer treatment in a study published in Cancer, suggesting that both high-risk patients and high-risk regions should be prioritized by clinical and policy strategies to improve care disparities.
Delays in breast cancer diagnosis and treatment have been associated with worse disease-specific and overall survival in previous research, and Black patients are at a disproportionately high risk of breast cancer treatment delays.
The large, population-based cohort study explored variations in time from breast cancer diagnosis to treatment in North Carolina between 2004 and 2017 based on 2 distinct patient characteristics: race and the geographic region in which patients reside. The analysis showed that Black patients were more likely to experience delays in treatment, as were patients of any race or ethnicity who lived in certain regions.
A total of 32,626 patients were included in the study, 6190 of whom (19%) were Black. These patients were younger than the remainder of the cohort (64 years vs 68 years), were more likely to receive chemotherapy before any other treatments (14.8% vs 7.6%), and their tumors were more likely to be hormone receptor negative (29.3% vs 15.6%) compared with the non-Black cohort.
Black patients were also more likely to have Medicaid insurance (46.7% vs 14.9%) and more often lived within 5 miles of their treatment site (30.6% vs 25.2%) than non-Black patients. They were also more likely to live in a Census tract in the highest social deprivation category (52% vs 18.6%) compared with non-Black patients in the cohort.
Treatment delays longer than 60 days, a threshold consistently linked to worse outcomes, were more common for Black patients, 15% of whom experienced such delays. In the non-Black cohort, 8% of patients faced a delay longer than 60 days. The median time to treatment for Black patients was 30 days vs 26 days for non-Black patients.
For both Black and non-Black patients, the likelihood of treatment delays varied between regions of the state. In the region with the highest risk of delays, patients were twice as likely to experience a delay compared with patients in the region with the lowest risk of delays. The magnitude of racial disparity also varied by region, with one region showing no significant difference—although only 2.7% of patients in this region were Black—and the most significant disparity being 9.4%.
“Importantly, regional differences in timeliness were not explained by the clinical or sociodemographic characteristics [of] patients,” the authors wrote. “The substantial geographic variation we observed in the delivery of timely and equitable breast cancer care suggests that these outcomes are modifiable and should be a clinical and policy priority for intervention in regions of high risk.”
Overall, the findings highlight multiple factors that may affect disparities in the timeliness of breast cancer care. Identifying areas where delays are common and exploring the various aspects of care delivery in these areas will be a crucial area of research going forward, the authors wrote. Further research into delays in other cancer types is also warranted.
“On average, about 1 in 7 Black women in our study experienced a lengthy delay, but this risk varied depending on where the woman lives in the state. These delays weren’t explained by the patient’s distance from cancer treatment facilities, their specific stage of cancer or type of treatment, or what insurance they had,” study author Katherine E. Reeder-Hayes, MD, MBA, MS, of the UNC Lineberger Comprehensive Cancer Center, said in a statement. “These findings suggest that the structure of local health care systems, rather than characteristics of the patients themselves, may better explain why some patients experience treatment delays and other adverse cancer outcomes.”
Reeder-Hayes KE, Jackson BE, Baggett CD, et al. Race, geography, and risk of breast cancer treatment delays: a population-based study 2004–2015. Cancer. Published online January 23, 2023. doi:10.1002/cncr.34573