Young black, Hispanic + poor breast cancer patients face treatment delays

Young African American, Hispanic, uninsured, publicly insured and low socioeconomic status women with breast cancer experience delays in treatment and decreased survival time, according to a health disparities study published April 24 in JAMA Surgery.

Although women between the ages of 15 and 39 years account for 5 to 6 percent of breast cancer cases, their prognosis is worse than older women. However, few studies have examined factors such as treatment delays, race/ethnicity and socioeconomic status.

Erlyn C. Smith, MD, from the department of epidemiology at University of California, Irvine, and colleagues devised a retrospective case study focused on 8,860 young breast cancer patients diagnosed from 1997 to 2006.

The researchers mined the California Cancer Registry database to glean information about treatment delay (the number of weeks between diagnosis and definitive treatment) and patient demographics, including age, socioeconomic status, race/ethnicity and insurance status. They selected survival as the outcome variable.

Although the mean treatment delay was 2.7 weeks, there was substantial variability among subgroups. Among women with delays of six weeks or longer, the largest groups were Hispanic and African American women. A total of 17.5 percent of low socioeconomic status women faced delays of six weeks or more compared to 7.7 percent of the high socioeconomic group.

Five-year survival among women with treatment delays more than six weeks was 78 percent, compared with 84 percent for delays less than two weeks and 83 percent for delays between two and four weeks.

Five-year survival for African American women was 73 percent, for Hispanic women 78 percent. White women averaged 85 percent five-year survival and Asian women 86 percent.

Insurance status also factored into five-year survival. Women with public or no insurance had 69 percent five-year survival compared with 86 percent among those with private insurance.

Finally, women with low socioeconomic status had 72 percent five-year survival compared with 89 percent among high socioeconomic status women.

Surgical delay time posed a significant risk factor for reduced survival for young women, according to Smith et al. They offered several possible patient- and physician-related explanations. It may be difficult for physicians to schedule surgery for women without insurance or pending public insurance. Pregnancy status, which was not included in the registry, also may be a factor. Anecdotal information suggests young women may present to primary care providers multiple times prior to a diagnosis.

An accompanying critique authored by Leigh Neumayer, MD, MS, of the department of surgery at Huntsman Cancer Hospital in Salt Lake City, noted that the study provides additional evidence of healthcare disparities associated with decreased survival and issued a call to eliminate these disparities.

“In conclusion, it is crucial to prevent further physician related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life,” added Smith et al.

For more about disparities in breast cancer screening, please look for “Mammo’s missing: Underserved & overlooked,” in the upcoming May/June issue of Health Imaging magazine.