The Waiting Game: How Long Are Breast Cancer Patients Waiting for Definitive Diagnosis?

Kovar, Alexandra; Bronsert, Michael; Jaiswal, Kshama; Murphy, Colleen; Wolverton, Dulcy; Ahrendt, Gretchen; Tevis, Sarah E.

doi:10.1245/s10434-020-08484-9

Cited by 8 publications

(12 citation statements)

References 14 publications

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“… 20 Study of the SEER-Medicare database found non-White race to be a significant predictor of delays in diagnosis. 21 During the COVID-19 restrictions, in our safety-net population, we found a doubling in the median time from symptom onset to diagnosis. Interestingly, we did not find race to be significantly associated with delays in diagnosis in our study.…”

Section: Discussionmentioning

confidence: 78%

Impact of COVID-19 Restrictions on Stage of Breast Cancer at Presentation and Time to Treatment at an Urban Safety-Net Hospital

et al. 2022

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Background COVID-19 disrupted health systems across the country. Pre-pandemic, patients accessing our urban safety-net hospital presented with three-fold higher rates of late-stage breast cancer than other Commission-on-Cancer sites. We sought to determine the effect of the COVID-19 pandemic on stage of breast cancer presentation and time to first treatment at our urban safety-net hospital. Methods An Institutional Review Board-approved cohort study of newly diagnosed breast cancer patients was conducted at our safety-net hospital comparing a COVID cohort (March 2020–February 2021, n = 82) with a pre-COVID cohort (March 2018–February 2019, n = 90). Demographic information, stage at presentation, and time to first treatment—subdivided into time from symptom to diagnosis and diagnosis to treatment—were collected and analyzed for effect of COVID pandemic. Results Cohorts were similar in age, race, and payor. More patients had late-stage disease during COVID (32%) than pre-COVID (19%, p = 0.05). There was a significantly longer time to first treatment during COVID ( p = 0.0001) explained by a significantly longer time from symptom to diagnosis ( p = 0.0001), with no difference in time from diagnosis to treatment. Conclusion It was significantly more likely for patients to present to our safety-net hospital with late-stage breast cancer during COVID than pre-COVID. There was longer time to first treatment during COVID, driven by the increased time from symptom to diagnosis. Patients may have perceived that care was inaccessible during the pandemic or had competing priorities, driving delays. Efforts should be made to minimize disruption to safety-net hospitals during future shut-downs as these are among the most vulnerable patients.

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Section: Discussionmentioning

confidence: 78%

Impact of COVID-19 Restrictions on Stage of Breast Cancer at Presentation and Time to Treatment at an Urban Safety-Net Hospital

et al. 2022

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Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that individual-level factors, such as race and ethnicity, insurance status, and education, are associated with diagnostic and treatment delay after abnormal mammography results . Several studies have reported that women from racial and ethnic minority groups, such as Asian, Black, and Hispanic women, are more likely to experience longer times to diagnosis or treatment . However, few studies approach these disparities using a framework like the one promoted by the National Institute of Minority Health and Health Disparities (NIMHD), which emphasizes that multiple levels of influence, such as neighborhood socioeconomic status and health care factors, can impact health outcomes .…”

Section: Introductionmentioning

confidence: 99%

Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity

et al. 2022

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ImportanceDiagnostic delays in breast cancer detection may be associated with later-stage disease and higher anxiety, but data on multilevel factors associated with diagnostic delay are limited.ObjectiveTo evaluate individual-, neighborhood-, and health care–level factors associated with differences in time from abnormal screening to biopsy among racial and ethnic groups.Design, Setting, and ParticipantsThis prospective cohort study used data from women aged 40 to 79 years who had abnormal results in screening mammograms conducted in 109 imaging facilities across 6 US states between 2009 and 2019. Data were analyzed from February 21 to November 4, 2021.ExposuresIndividual-level factors included self-reported race and ethnicity, age, family history of breast cancer, breast density, previous breast biopsy, and time since last mammogram; neighborhood-level factors included geocoded education and income based on residential zip codes and rurality; and health care–level factors included mammogram modality, screening facility academic affiliation, and facility onsite biopsy service availability. Data were also assessed by examination year.Main Outcome and MeasuresThe main outcome was unadjusted and adjusted relative risk (RR) of no biopsy within 30, 60, and 90 days using sequential log-binomial regression models. A secondary outcome was unadjusted and adjusted median time to biopsy using accelerated failure time models.ResultsA total of 45 186 women (median [IQR] age at screening, 56 [48-65] years) with 46 185 screening mammograms with abnormal results were included. Of screening mammograms with abnormal results recommended for biopsy, 15 969 (34.6%) were not resolved within 30 days, 7493 (16.2%) were not resolved within 60 days, and 5634 (12.2%) were not resolved within 90 days. Compared with White women, there was increased risk of no biopsy within 30 and 60 days for Asian (30 days: RR, 1.66; 95% CI, 1.31-2.10; 60 days: RR, 1.58; 95% CI, 1.15-2.18), Black (30 days: RR, 1.52; 95% CI, 1.30-1.78; 60 days: 1.39; 95% CI, 1.22-1.60), and Hispanic (30 days: RR, 1.50; 95% CI, 1.24-1.81; 60 days: 1.38; 95% CI, 1.11-1.71) women; however, the unadjusted risk of no biopsy within 90 days only persisted significantly for Black women (RR, 1.28; 95% CI, 1.11-1.47). Sequential adjustment for selected individual-, neighborhood-, and health care–level factors, exclusive of screening facility, did not substantially change the risk of no biopsy within 90 days for Black women (RR, 1.27; 95% CI, 1.12-1.44). After additionally adjusting for screening facility, the increased risk for Black women persisted but showed a modest decrease (RR, 1.20; 95% CI, 1.08-1.34).Conclusions and RelevanceIn this cohort study involving a diverse cohort of US women recommended for biopsy after abnormal results on screening mammography, Black women were the most likely to experience delays to diagnostic resolution after adjusting for multilevel factors. These results suggest that adjustment for multilevel factors did not entirely account for differences in time to breast biopsy, but unmeasured factors, such as systemic racism and other health care system factors, may impact timely diagnosis.

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confidence: 99%

“…These findings are consistent with prior studies demonstrating breast cancer diagnostic and treatment delays by race and ethnicity following a positive screening mammogram. Kovar et al found that race was an independent risk factor for delayed breast cancer diagnosis in their evaluation of time from abnormal mammogram to biopsy, surgeon visit, and breast surgery. In their study, American Indian/Alaska Native patients (OR, 1.68; 95% CI, 1.53-1.84) had the highest likelihood of delay, followed by Black (OR, 1.65; 95% CI, 1.53-1.78), Hispanic (OR, 1.56; 95% CI, 1.43-1.71), and Asian/Pacific Islander women (OR, 1.26; 95% CI, 1.43-1.71) compared with White women in their study.…”

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confidence: 99%

Addressing Racial and Ethnic Differences in Diagnostic Resolution of Abnormal Mammographic Findings

Miles

2022

JAMA Oncol

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The Waiting Game: How Long Are Breast Cancer Patients Waiting for Definitive Diagnosis?

Cited by 8 publications

References 14 publications

Impact of COVID-19 Restrictions on Stage of Breast Cancer at Presentation and Time to Treatment at an Urban Safety-Net Hospital

Impact of COVID-19 Restrictions on Stage of Breast Cancer at Presentation and Time to Treatment at an Urban Safety-Net Hospital

Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity

Addressing Racial and Ethnic Differences in Diagnostic Resolution of Abnormal Mammographic Findings

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