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Delays in Breast Cancer Diagnosis and Treatment by Racial/Ethnic
Group
Sherri Sheinfeld Gorin, PhD; Julia E. Heck, PhD; Bin Cheng, PhD; Suzanne J. Smith, MD
Background: Although white women have the highest incidence of breast
cancer, African American, followed by Hispanic, American Indian/Alaskan Native, and
Asian American or Pacific Islander, women have higher death rates from the
disease.
Timely initiation of treatment has been shown to improve survival, and
may help to lessen the mortality differences among racial/ethnic groups.
Methods: The purpose of this study was to describe time delays in the
initial diagnosis and treatment of primary breast carcinoma across diverse
ethnic/racial groups. Data are from the Surveillance, Epidemiology, and End
Results-Medicare database.
Women in this study were diagnosed as having breast cancer
between January 1, 1992, and December 31, 1999. Billing claims from outpatient
and inpatient visits were used. A total of 49 865 female Medicare recipients 65
years and older were enrolled in the study. Racial/ethnic groups were compared
in their diagnostic, treatment, and clinical delay (ie, women with a
diagnostic and treatment delay).
Results: African American women experienced the greatest diagnostic,
treatment, and clinical delay. After controlling for other predictors, compared with
white women, African American women had a 1.39-fold odds (95% confidence
interval, 1.18-1.63) of diagnostic delay beyond 2 months, a 1.64-fold odds (95%
confidence interval, 1.40-1.91) of treatment delay beyond 1 month, and a
2.24-fold odds (95% confidence interval, 1.75-2.86) of having a combined clinical
delay.
Conclusions: In a population-based study, African American women experienced
the most delays in initial diagnosis and initiation of breast cancer
treatment, relative to women of other racial/ethnic subgroups. Despite the limitations
of a claims database, the magnitude and direction of the findings are
consistent across the research, suggesting the critical importance of reducing these
delays.
Arch Intern Med. 2006;166:2244-2252.
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