Race is the most pronounced driver of delayed breast cancer diagnosis during regular screenings, according to a new study in the Journal of the American College of Radiology.
Mortality rates from the disease have declined steadily over the last decade, thanks to national mammography screening programs, among other factors. But “substantial” barriers to screening and primary care still exist, which can result in delayed treatment and poor outcomes.
Analyzing data from more than 700 women diagnosed with breast cancer in their Atlanta health system, Emory University researchers found some stark differences. Black women were twice as likely to experience total delays greater than 45 days compared with white women. And those with such a long lag after screening were 1.6 times more likely to die, authors found.
“Our results suggest that race is the most pronounced driver of delays in the diagnosis of screen-detected [breast cancer]. As such, necessary steps must be taken to identify the personal and structural barriers that influence timely receipt of care for Black women,”
Jasmine Miller-Kleinhenz, PhD, with Emory University’s Department of Epidemiology, and co-authors wrote July 16. “Further understanding the contribution of delays in BC diagnosis to racial disparities in BC outcomes is needed to inform strategies to reduce the mortality gap,” they added.
For their study, researchers tapped health records from their system logged between 2010-2014. All told, 362 white women were screened and received subsequent breast cancer diagnoses at Emory during that window, alongside 368 Black women. Miller-Kleinhenz et al. also calculated patients’ odds of experiencing a delay to diagnostic evaluation (greater than 30 days), biopsy (15-plus days) and a total delay of greater than 45.
Black women, those diagnosed with later stages of breast cancer, larger tumor sizes, and triple-negative tumors were all more likely to experience lengthy delays to diagnosis. Adjusting for various factors, Black women had a twofold increase in the odds of delay to diagnostic evaluation (odds ratio 1.98), biopsy delays (2.41), and total delays of 45-plus days (2.22). Women residing in lower socioeconomic-status neighborhoods also had a longer median number of days of total delay to diagnosis (42 vs 28 days) than those residing in higher-income areas.
“Our results also suggest that area-level [socioeconomic status] is an important factor driving delays in BC diagnostic evaluation,” the authors noted. “These findings may suggest that systemic inequities (i.e., provider biases, discrimination, social and physical environments), rather than race itself, are fundamental drivers of delay, as observed in the present study,” they added later. “Understanding what barriers contribute to black women’s encountering delays in diagnostic evaluation requires further study and is necessary for determining what interventions are required to reduce this disparity.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.