African American Women Receiving Radiation Face Breast Cancer Treatment Delays

September 22, 2020

Radiation, alongside age and socioeconomic status, is associated with longer diagnosis-to-treatment timelines.

African American women with breast cancer are more likely to run into treatment delays and longer treatment courses than their white counterparts, according to newly published research. And, the findings, that point to radiation as a significant contributing factor to these challenges, add to the already bleak picture of what African American women face with this disease.

The industry already knows 31 percent of African American women die from breast cancer – that amount is 42 percent higher than white women. In a study published Sept. 21 in Cancer, investigators from the University of North Carolina at Chapel Hill and the Lineberger Comprehensive Cancer Center set out to find out why this is the case when both groups develop breast cancer at relatively comparable rates.

“Black women with low [socioeconomic status] and more barriers to care had substantial proportions of prolonged treatment duration, especially when radiation therapy was part of the treatment,” wrote the team led by Melissa Troester, Ph.D., co-leader of the Lineberger cancer epidemiology program.

This research comes on the heels of research from the Society of Breast Imaging, published in the Journal of Breast Imaging, that revealed African American women already face obstacles in getting timely and effective breast cancer screening. According to that study, African American women are more likely to develop aggressive breast cancer at an age younger than when screening mammography is typically recommended.

Related Content: Race-Related Cancer Disparities Fall with Screening Mammography

In this latest study, Troester and her colleagues looked at 2,841 women with Stage 1 to Stage 3 cancers and determined that African American do face particular obstacles that increase their chances of having longer treatment times. Many of these barriers directly impact radiation treatments, they said.

Troester’s team pulled their data from the Carolina Breast Cancer Study, a population-based study of women with invasive breast cancer that examines disparities in care. Women included in the study were diagnosed between 2008 and 2013 between the ages of 20 and 74. The study population was divided evenly between African American and white women, as well as those who were young than 50 and those who were older.

While the overall average time from diagnosis to treatment was 34 days, roughly 11 percent of all women in the study had at least a 60-day delay to therapy initiation. And, women who had one setback were more likely to have multiple.

This problem plagued African American women at higher rates, according to the team's analysis. Based on their evaluation, 13.4 percent of African American women experienced delayed treatment compared to 7.9 percent of white women. Additionally, they had longer treatment times than white women, 29.9 percent and 21.1 percent, respectively.

Breast Cancer Treatment Delays and Extensions According to Age and Race

Patient CharacteristicTop 25 Percent Treatment Duration>60-day Treatment Delay
White women21.1 percent7.9 percent
African American women29.9 percent13 percent
Older than 50 years23.8 percent10.7 percent
Younger than 50 years27 percent10.5 percent

The impact was even greater for African American women who were under age 50. Among this group, 32 percent were in the top quarter for treatment duration. In contrast, 22.3 percent of younger white women fell into this group. Even more older African American women landed in this top quartile (27.9 percent) than did older white women (19.9 percent).

Troester and her colleagues also found that socioeconomic status did not help African American women much. Among those in a higher socioeconomic bracket, 11.7 percent of African American women still experienced treatment delays compared to 6.7 percent of white women. This finding extended into lower socioeconomic groups, as well.

“Even among women with low socioeconomic status, we still saw fewer delays among white women, underscoring the disparate experience of black women, who appear to experience unique barriers,” said lead author Marc Emerson, Ph.D., MPH, an epidemiology postdoctoral fellow at Lineberger.

Including radiation as part of a woman’s treatment also led to delays, the team found, especially if a woman faced barriers to care. Specifically, women were 22 percent more likely to have delayed treatment if they chose radiation and surgery and only 1.6 percent more likely with chemotherapy and surgery.

Other issues also contributed to treatment slowdowns, Troester said.

“It is important to recognize that the causes of delay are complex and reflect both individual barriers and system level factors,” she said, pointing to financial and transportation issues.

Radiation also played a role here. If a woman undergoing radiation and surgery also faced a transportation issue, she was 25-percent more likely to have longer treatment times, and for a woman with a financial obstacle, the likelihood of extended treatment times was 15 percent higher.

Overall, the team noted, the factors that affect treatment timeliness can be felt throughout the care continuum. 

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