Factors Associated with Delays to Diagnosis and Treatment of Breast Cancer in Women in a Louisiana Urban Safety Net Hospital

Abstract

Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.

Análise dos determinantes que influenciam o tempo para o início do tratamento de mulheres com câncer de mama no Brasil

“…Neste estudo, as características que influenciaram no desfecho para o conjunto do país foram: ano do diagnóstico, estadiamento da doença, origem do encaminhamento, raça/cor da pele, escolaridade e estado conjugal, corroborando, em sua maioria, estudos anteriores 11,17,27,28,29,30 . Porém, na análise múltipla estratificada por macrorregiões do Brasil, os resultados obtidos demonstram diversidade de fatores que interferem no intervalo de tempo entre o diagnóstico e o início do tratamento do câncer de mama.…”

Diagnosis and Surgical Delays in African American and White Women with Early-Stage Breast Cancer

“…8,[33][34][35] Inability to differentiate the type and sequence of therapy, particularly neoadjuvant, radiation and surgical treatment sequence, was a limitation for many of the previous investigations. Although time is required for preoperative evaluation before the appropriate surgery is performed, it is shown that ‡ 2 months delay in initiating surgical treatment can negatively impact survival.…”

Uwarunkowania opóźnień w diagnostyce i terapii kobiet chorych na raka piersi w Polsce związane z postawami chorych

“…Zaobserwowano jednak pewną poprawę w zakresie obniżenia stopnia zaawansowania nowotworu w momencie rozpoznania [1], chociaż rozpoczęcie leczenia przez chore na raka piersi w Polsce nadal jest opóźnione. Opóźnienie w podjęciu leczenia nie jest wyłącznie polskim doświad-czeniem [3,[5][6][7][8][9][10][11][12][13]. Wśród przyczyn opóźnienia wymieniane są przyczyny zależne od chorych, od lekarzy oraz systemu opieki zdrowotnej [14].…”

“…w czerniaku, jest lepsze, jeżeli rozpoznanie zostanie postawione w czasie krótszym niż 3 miesiące od pierwszych objawów klinicznych [5,15]. Na opóźnienie procesu diagnostyczno-terapeutycznego ze strony chorych wpływa szereg czynników, w tym wiek, stan społeczno-ekonomiczny, wykształcenie, czynniki etniczne, kulturowe i psychologiczne [3,5,[6][7][8][9][16][17][18]. Wszystkie te elementy warunkują w mniejszym lub większym stopniu zachowania zdrowotne i mogą wpływać na zmniejszenie lub zwiększenie opóźnienia.…”