Variations in time to receiving first surgical treatment for breast cancer as a function of racial/ethnic background

Abstract

6566 Background: Multiple studies have shown differences in the type of breast cancer treatment received, related to race/ethnicity or socioeconomic status. This study investigates racial disparities in time to receiving first surgical treatment (i.e., surgical delay) in patients with breast cancer. Methods: Patients admitted at two affiliated hospitals for breast cancer treatment during 2001- 2006 were identified. Time to receiving surgery or surgical delay was defined as the time in days between diagnosis (biopsy) and definitive surgical treatment (lumpectomy or mastectomy). Unadjusted comparisons between racial/ethnic groups were made using the Kruskal-Wallis Test (KW). A multivariate linear regression model was used to predict the natural logarithm of time to receiving surgery by racial/ethnic group. Adjustments were made for several factors including age, diagnosis year, AJCC stage, type of surgery, hospital, number of comorbidities and insurance status. Results: 2,845 patients who were first treated with surgery were identified. Racial background was classified as White, African American, or Asian/Other. Average age was 58.7 years (SD = 13.5). Overall median time to surgery was 16.5 days; 15.5 days in whites, 22.5 and 19.5 days in African Americans and Asian/others, respectively (p = 0.002, by KW). Multivariate linear regression analyses (table) showed that only African Americans, not Asian/others, had significantly increased surgical delay compared to whites (p = 0.001). Surgical delay also significantly increased with older age, more recent diagnosis year (not shown), mastectomy vs. lumpectomy, and for patients without comorbid conditions. Higher AJCC stage was also variably related to surgical delay. No statistically significant relationship to surgical delay was observed for either hospital or insurance status. Conclusions: This study demonstrates racial differences in time to first surgical treatment in a group of ethnically diverse breast cancer patients. Factor Mean or % Beta 95% CI p-value Race group (vs. White) African American 5.4% 0.50 (0.20,0.81) 0.001 Asian/Other 4.5% 0.05 (-0.29,0.38) 0.79 Age (per 10 years) 58.7 0.08 (0.03,0.13) 0.003 AJCC stage: 2 (vs. 0 or 1) 27.7% 0.15 (-0.01,0.32) 0.059 AJCC stage 3+ (vs. 0 or 1) 7.9% 0.28 (0.01,0.55) 0.042 Surgery type (mast. vs. lump.) 37.5% 0.33 (0.18,0.48) <0.001 Insurance (yes vs. no) 96.6% -0.19 (-0.71,0.33) 0.48 At least one comorbidity (vs. none) 31.5% -0.29 (-0.49,-0.09) 0.004 Model includes intercept (not shown) No significant financial relationships to disclose.