Abstract 865: Impact of race and health insurance on delays in breast cancer diagnosis and treatment in the District of Columbia

Abstract

Abstract Background: Delays in follow-up after breast cancer screening are thought to contribute to disparities in breast cancer outcomes. The primary objective of this study is to determine the impact of race as well as health insurance status on the diagnostic delay time, defined as the number of days from abnormal screening to definitive diagnosis. In addition, we analyze the effects of race and health insurance status on the treatment delay time, defined as the number of days from definitive breast cancer diagnosis to treatment initiation. Methods: This is a retrospective study of 695 women examined for breast cancer between 1997 and 2009 at seven hospitals and clinics located in the District of Columbia. The outcomes of interest were the diagnostic delay time and the treatment delay time. We used full-factorial and main-effects ANOVA models to test for significant differences in these outcomes between African-American and white women with and without some type of health insurance. Results: The mean diagnostic delay time was 37 days for insured white women, 76 days for uninsured white women, 75 days for insured African-American women, and 73 days for uninsured African-American women. In fitting a full-factorial ANOVA model, we found that insured white women had a significantly shorter delay in diagnosis than insured African-American women (p=0.0001) as well as uninsured white women (p=0.0007). Furthermore, a main-effects ANOVA model showed that after controlling for insurance status, African-American women had a mean treatment delay time of 45 days, which was significantly longer than the mean treatment delay time of only 17 days for white women (p<0.0001). Insurance status, however, had no significant effect on the treatment delay time after controlling for race (p=0.72). Conclusions: Insured African-American women and uninsured white women waited more than twice as long to reach their definitive diagnosis than insured white women. African-American women also waited more than three times as long as white women for treatment initiation following definitive diagnosis. Lack of health insurance markedly decreased the speed of diagnostic resolution in white women, but having health insurance did not increase the speed of diagnostic resolution in African-American women. These results suggest that lack of health insurance may not be the primary barrier to optimal diagnostic resolution and treatment initiation in African-American women. It will be important to determine what other factors serve as the primary barriers, as well as if these delays affect the final breast cancer outcome for the patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 865.