Role of race and health insurance status in breast cancer diagnosis and treatment

Researchers at The GW Cancer Institute, with funding from the National Cancer Institute, examined the effect of race and health insurance status on diagnostic and treatment delays over a 5-year period, with initial screenings going back 12 years, and found that race may play a larger role than previously thought when it comes to optimal diagnosis and treatment of black women with breast cancer.

"We thought having health insurance would even the field and that insured black women would have had the same rate of evaluation as insured white women, but that was not the case in our study," said Heather Hoffman, Ph.D., assistant professor of Epidemiology and Biostatistics at The George Washington University School of Public Health and Health Services.

Dr. Hoffman and colleagues conducted a retrospective, cohort study of 581 women with breast cancer. Women were examined between 1997 and 2009 at seven hospitals and clinics in Washington, D.C. Diagnostic delay time was defined as the number of days from abnormal screening to diagnosis, and treatment delay time was defined as the number of days from diagnosis to treatment initiation.

According to Dr. Hoffman, the goal was to identify risk factors associated with delays in diagnosis. They found the following:

• insured black women and uninsured white women waited more than twice as long to reach their definitive diagnosis than insured white women;
• lack of health insurance decreased the speed of diagnosis in white women, but having insurance did not increase the speed of diagnosis in black women; and
• overall, black women waited twice as long as white women for treatment initiation following definitive diagnosis.

Based on the results of this study, the researchers suggest that increased outreach, education and patient navigation efforts be made to improve to try to improve diagnostic time and explain the importance of timely medical follow-up.

"Black women should be the focus of breast cancer screening outreach and follow-up because they experience greater delays in diagnosis and in treatment than white women, regardless of insurance status," said Dr. Hoffman. "We need to determine what other barriers contribute to diagnosis and treatment delays in insured black women and all uninsured women."

Source The George Washington University Medical Center