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Race is the most significant contributor to delays with breast cancer diagnosis.
Screening efforts have succeeded in improving mammography rates among Black women over the past 30 years, but this same group of women experience at least a two-fold increase in delays for diagnostic evaluation and biopsy, leading to a higher mortality level.
In fact, according to a team of investigators from Emory University, race is the most pronounced factor in delayed diagnoses of screening-detected breast cancers. In an article published July 16 in the Journal of Digital Imaging, they demonstrated that diagnostic delays can result in a 1.6-fold increase in mortality from breast cancer.
“We found that Black women were at least twice as likely to experience delays at each stage of the diagnostic process compared with white women,” the team said. “Interestingly, in our study, race was the only patient characteristic associated with delay to biopsy; Black women had a 2.4-fold increase in the odds of delay to biopsy compared with white women.”
These results highlight that there are still significant barriers to primary care, screening, and diagnostic services that can lead to negative outcomes.
For their study, the team enrolled 730 women – 362 white and 368 Black – who underwent breast cancer screening prior to diagnosis at the Emory University Breast Imaging Center between Jan. 1, 2010, to Dec. 31, 2014. They examined time intervals to diagnostic evaluation (less than or more than 30 days), time to biopsy (less than or more than 15 days), and total time delay (less than or more than 45 days).
Overall, they found that Black women and those from lower socioeconomic-status neighborhoods experienced longer delays and worse outcomes. Across all categories, delays were 60 percent greater for Black women than their white counterparts, averaging 10 days longer. In addition, women in lower socioeconomic neighborhoods also had a 1.69-fold increase in total delays – 42 days compared with 28 days for women in wealthier neighborhoods.
The team also discovered that women who had total delays of more than 45 days were more likely to have later-stage tumors, and women who had diagnostic delays were less likely to be diagnosed with ER+ disease, pointing to a need for truncated time intervals.
“Given that ER- tumors (particularly triple-negative breast cancer) are more likely to have an aggressive phenotype and poorer prognosis compared with ER+ tumors,” they explained, “it is imperative to ensure that women at highest risk for aggressive tumor types (namely, Black and young women) are evaluated in a timely manner.”
From the perspective of breast cancer mortality, the team determined that women who experience total delays of more than 45 days had a 1.57-fold increase in the odds of dying from breast cancer than women who did not have delays. And, among those who did have delays, Black women had a 1.6-fold odds increase of dying than did white women.
More work is needed, they said, to fully understand the impact of diagnostic delays on racial disparities in the context of breast cancer. But, their findings make it clear that Black women still face significant barriers than negatively impact their care.
“Our results suggest that race is the most pronounced driver of delays in the diagnosis of screen-detected breast cancer,” they concluded. “As such, necessary steps must be taken to identify the personal and structural barriers that influence timely receipt of care for Black women.”
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