What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

Abstract

Background: Delayed diagnosis of breast cancer (BC) may contribute to adverse outcomes, such as reduced survival. The purpose of this study was to identify correlates of elapsed time between recognition of breast abnormalities and receipt of definitive diagnosis of BC among low-income women. Methods: Data were obtained from a cross-sectional study among a statewide sample of 921 low-income women with a new diagnosis of BC. Patients were grouped by whether their breast abnormalities were self-detected or healthcare system detected. Multivariate logistic regression analyses were used to examine associations between diagnostic delay and patient characteristics, patient communication, and system characteristics. Results: The self-detected group experienced much greater delay than the system-detected group (median intervals 80.5 vs. 31.5 days). African Americans had the longest intervals between symptom detection and diagnostic resolution; median delays in the self-detected and system-detected subgroups were 115 and 70 days, respectively, compared to 64 and 22 days for Caucasians. In multivariate analyses, African Americans had considerably greater odds of > 60-day delay than Caucasians in both the self-detected (odds ratio [OR] 3.51) and system-detected (OR 5.36) groups. Greater perceived self-efficacy in interacting with healthcare providers was significantly associated with shorter delay among the self-detected group (OR 0.86). Conclusions: Disparities in timely BC diagnosis between African Americans and Caucasians were pronounced in this uniformly low-income population of women. Women with self-detected abnormalities had markedly greater delays than those with healthcare system-detected abnormalities. Among this vulnerable group, increasing self-efficacy in interacting with healthcare providers may reduce diagnostic delays.

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

“…26 But only a few studies have examined the impact of self-recognition of symptoms, primarily owing to difficulty in capturing this information. 23,27,28 We found that patients who self-detected their cancer were more likely to experience diagnosis delay as compared to patients whose cancer was detected through CBE or screening mammography for both groups. The proportion of patients with ‡ 2 months diagnosis delay was higher among AA patients than in white patients, irrespective of the method of detection.…”

Participants' barriers to diagnostic resolution and factors associated with needing patient navigation

“…Previous research found similar results, identifying measures of SES (i.e., income, insurance status) and other demographic factors (i.e., race, education) as important determinants of timely follow-up after abnormal screening tests. 26–30 …”

Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

“…The goal of an organized mammography screening program is to offer high level medical care to every woman at a reasonable expense. Previous studies have shown barriers to entry into the health system for low income women and women in an area with inadequate mammography capacity, resulting in delays in diagnosis (Elkin et al, 2010;Maly et al, 2011). Providing mobile mammography services with community organizations, can be effective in increasing access and decreasing barriers to screening hard-to-reach populations.…”