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. 2021 Oct;18(10):1384-1393.
doi: 10.1016/j.jacr.2021.06.019. Epub 2021 Jul 17.

Racial Disparities in Diagnostic Delay Among Women With Breast Cancer

Jasmine M Miller-Kleinhenz  1 , Lindsay J Collin  2 , Rebecca Seidel  3 , Arthi Reddy  4 , Rebecca Nash  4 , Jeffrey M Switchenko  5 , Lauren E McCullough  4
Affiliations

Racial Disparities in Diagnostic Delay Among Women With Breast Cancer

Jasmine M Miller-Kleinhenz et al. J Am Coll Radiol. 2021 Oct.

Abstract

Purpose: Early diagnosis is fundamental to reducing breast cancer (BC) mortality, and understanding potential barriers from initial screening to confirmed diagnosis is essential. The aim of this study was to evaluate patient characteristics that contribute to delay in diagnosis of screen-detected cancers and the contribution of delay to tumor characteristics and BC mortality.

Methods: Three hundred sixty-two White and 368 Black women were identified who were screened and received subsequent BC diagnoses within Emory Healthcare, a part of Emory University health care system (2010-2014). Multivariable-adjusted logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associating patient characteristics with delay to diagnostic evaluation (≥30 versus <30 days), delay to biopsy (≥15 versus <15 days), and total delay (≥45 versus <45 days). Additionally, the ORs and 95% CIs associating delay with tumor characteristics and BC mortality were computed.

Results: Black women and women diagnosed at later stages, with larger tumor sizes, and with triple-negative tumors were more likely to experience ≥45 days to diagnosis. In multivariable-adjusted models, Black women had at least a two-fold increase in the odds of delay to diagnostic evaluation (OR, 1.98; 95% CI, 1.45-2.71), biopsy delays (OR, 2.41; 95% CI, 1.67-3.41), and total delays ≥45 days (OR, 2.22; 95% CI, 1.63-3.02) compared with White women. A 1.6-fold increased odds of BC mortality was observed among women who experienced total delays ≥45 days compared with women without delays in diagnosis (OR, 1.57, 95% CI, 0.96-2.58).

Conclusions: The study demonstrated racial disparities in delays in the diagnostic process for screen-detected malignancies. Total delay in diagnosis was associated with an increase in BC mortality.

Keywords: Breast cancer; diagnostic delay; mortality; racial disparities.

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Conflict of interest statement

Conflicts of Interest: The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between diagnostic delay and patient tumor characteristics among 730 Black and White women with screen-detected breast cancer at an Emory University Breast Imaging Center (2010–2014). *Ordinal logistic regression
See this image and copyright information in PMC

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