Structural racism may play a part in Black and Latina patients failing to receive the best breast cancer care, according to a new analysis published Thursday.
Minority neighborhoods are likelier to house nonaccredited and under-resourced imaging facilities, which can produce inequities at the initial entryway into the healthcare system, experts wrote in JACR. But what about in terms of further downstream aspects of care?
Wanting to explore these questions, researchers looked to data from the Breast Cancer Care in Chicago study of newly diagnosed patients, treated at safety net hospitals and other institutions.
“These sites serve a disproportionate number of low-income patients and provide a substantial amount of uncompensated care,” Garth Rauscher, PhD, an associate professor of epidemiology at the University of Illinois at Chicago School of Public Health, and co-authors wrote July 8. “We were keenly interested to understand whether inequities in the resources and accreditation of the initial presentation facility might account for some of these disparities but were limited by the modest sample sizes available to us,” they added later.
For their study, Rauscher et al. pinpointed women newly diagnosed with a first primary in situ or invasive breast cancer between 2005 to 2008, conducting detailed interviews and medical records analyses. They additionally logged whether patients were treated at a Disproportionate Share Hospital that serves large volumes of individuals on Medicaid or without insurance, along with checking accreditation status.
Bottom line: Black and Hispanic patients were more likely to visit a DSH facility than their white counterparts and less likely to present at highly accredited institutions. They were also less likely to visit an institution certified as a Breast Imaging Center of Excellence or approved by the National Accreditation Program for Breast Centers. Racial and ethnic minority patients were also more likely to experience treatment delays while less likely to undergo a sentinel node biopsy or report being recommended for hormone therapy.
The study was limited by its small sample size, confinement to a single urban area, and reliance on older data. Rauscher and colleagues said they plan to further explore these questions in a much larger sample of women from the Breast Cancer Surveillance Consortium.
You can read the full analysis in the Journal of the American College of Radiology here.
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.