Delays In Breast Cancer Treatment Research Articles

Breast Cancer Treatment Delays at an Urban Safety Net Hospital Among Women Experiencing Homelessness.

Disparities in outcomes for vulnerable women is an ongoing problem. Homelessness and breast cancer treatment outcomes is understudied. This is a descriptive study exploring types of homelessness and treatment delays at an urban safety net hospital providing care to a vulnerable patient population.This study is a retrospective chart review of homeless female patients diagnosed with breast cancer between January 1, 2000 and December 31, 2014. Data for this study were acquired from the hospital cancer registry and electronic medical record. All demographic characteristics, time to treatment and factors related to delays to treatment were analyzed descriptively, reporting frequencies and proportions. The total number of individuals analyzed was 24. All except two subjects were delayed to treatment (≥ 30 days from diagnosis to treatment). Most women in this cohort were categorized as chronically homeless (46%) with the rest categorized as transitionally (29%) or episodically (12%) homeless. The majority of subjects (70%) were Black, non-Hispanic. All except one subject were publicly insured (71% Medicaid; 12% Medicare) or uninsured (8%). Regardless of type of homelessness, most subjects were either 30-60 or 60-90 days delayed. Those who were chronically homeless experienced significantly more delays to first treatment (56% of those who were delayed 30-60 days and 57% of those who were delayed 60-90 days; p value 0.006) than those who were episodically or transitionally homeless. Significant delays and barriers to breast cancer treatment exist among women experiencing homelessness. Further studies to improve breast cancer care for homeless women are warranted.

Costs after incident breast cancer diagnosis among high-deductible health plan members.

120 Background: High-deductible health plans (HDHP) are associated with breast cancer treatment delays of up to 10 months, but their impact on health outcomes is unknown. We hypothesized that, compared with women in generous plans, HDHP members would present with more advanced disease and thus experience higher total costs of early care. Methods: We studied 2004-2014 claims data from a large US health insurer. We included women aged 25-64 who were in traditional low-deductible (≤$500) health plans for 1 baseline year then experienced either an employer-mandated switch to HDHPs (≥$1000) for up to 4 or years or an employer-mandated continuation in low deductible plans. We defined the HDHP switch date as the index date. We then restricted to women who developed incident breast cancer after the index date. Using baseline characteristics, we closely matched HDHP members with incident breast cancer to contemporaneous women with incident breast cancer who remained in low-deductible plans. We measured total costs of all health care services in the 60 days after incident breast cancer diagnosis as a proxy for the intensity of incident breast cancer care. We used negative binomial regression adjusted for baseline characteristics to compare total 60-day costs among HDHP and control members. We also subset analyses to low-income women. Results: We included 1514 HDHP members and 9283 matched controls. 60-day costs after incident breast cancer diagnosis were $24,151 (95% CI: $22,766, $25,535) among HDHP members and $22,474 ($21,952, $22,996) among controls, an absolute difference of $1677 ($197, $3156) and a relative difference of 7.5% (8.1%, 14.1%). Low-income HDHP members had corresponding absolute and relative differences of $2653 ($368, $4939) and 12.5% (1.5%, 23.5). Conclusions: HDHP members with incident breast cancer had 7.5% higher health care costs in the 60 days after incident breast cancer than women with more generous coverage, a finding driven 12.5% higher costs among low-income HDHP members. Results raise concerns that delays in breast cancer care among HDHP members are associated with more advanced disease and adverse outcomes.

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study.

After controlling for baseline disease factors, researchers have found that black women have worse breast cancer survival, and this suggests that treatment differences may contribute to poorer outcomes. Delays in initiating and completing treatment are one proposed mechanism. Phase 3 of the Carolina Breast Cancer Study involved a large, population-based cohort of women with incident breast cancer. For this analysis, we included black women (n=1328) and white women (n=1331) with stage I to III disease whose treatment included surgery with or without adjuvant therapies. A novel treatment pathway grouping was used to benchmark the treatment duration (surgery only, surgery plus chemotherapy, surgery plus radiation, or all 3). Models controlled for the treatment pathway, age, and tumor characteristics and for demographic factors related to health care access. Exploratory analyses of the association between delays and cancer recurrence were performed. In fully adjusted analyses, blacks had 1.73 times higher odds of treatment initiation more than 60days after their diagnosis in comparison with whites (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.04-2.90). Black race was also associated with a longer treatment duration. Blacks were also more likely to be in the highest quartile of treatment duration (OR, 1.69; 95% CI, 1.41-2.02), even after adjustments for demographic and tumor characteristics (OR, 1.31; 95% CI, 1.04-1.64). A nonsignificant trend toward a higher recurrence risk was observed for patients with delayed initiation (hazard ratio, 1.44; 95% CI, 0.89-2.33) or the longest duration (hazard ratio, 1.17; 95% CI, 0.87-1.59). Black women more often had delayed treatment initiation and a longer duration than whites receiving similar treatment. Interventions that target access barriers may be needed to improve timely delivery of care.

Timeliness of Treatment Initiation in Newly Diagnosed Patients With Breast Cancer

BackgroundEvidence-based timeliness benchmarks have been established to assess quality of breast cancer care, as delays in treatment are associated with poor clinical outcomes. However, few studies have evaluated how current breast cancer care meets these benchmarks and what factors may delay the timely initiation of treatment. Patients and MethodsDemographic and disease characteristics of 377 newly diagnosed patients with breast cancer who initiated treatment at Tufts Medical Center (2009-2015) were extracted from electronic medical records. Time from diagnosis to initial surgery and time from diagnosis to initiation of hormone therapy were estimated with Kaplan-Meier curves. Multivariable regression analysis was used to identify factors associated with treatment delays. Thematic analysis was performed to categorize reasons for delay. ResultsOf 319 patients who had surgery recommended as the first treatment, 248 (78%) met the 45-day benchmark (median, 28 days; 25th-75th %, 19-43). After adjusting for potential confounders, multivariable regression analysis revealed that negative hormone receptor status (odds ratio, 3.48; 95% confidence interval, 1.44-8.43) and mastectomy (odds ratio, 4.07; 95% confidence interval, 2.10-8.06) were significantly associated with delays in surgery. Delays were mostly owing to clinical complexity or logistical/financial reasons. Of 241 patients eligible for hormone therapy initiation, 232 (96%) met the 1-year benchmark (median, 147 days; 25th-75th %, 79-217). ConclusionMost patients met timeliness guidelines for surgery and initiation of hormone therapy, although risk factors for delay were identified. Knowledge of reasons for breast cancer treatment delay, including clinical complexity and logistical/financial issues, may allow targeting interventions for patients at greatest risk of care delays.

Analisis Faktor Yang Mempengaruhi Keterlambatan Pengobatan Pada Wanita Penderita Kanker Payudara Di Rumah Sakit Umum Daerah Simeulue Tahun 2018

Kanker payudara dapat dideteksi dini dengan melakukan pemeriksaan payudara sendiri (SADARI) yang bertujuan mencegah risiko tingkat lanjut dan dapat menurunkan angka kematian pada penderita, karena kanker dapat ditemukan lebih awal sehingga akan memberikan harapan hidup yang lebih lama. Tujuan peneliti ini untuk mengetahui faktor keterlambatan pengobatan pada wanita penderita kanker payudara di RSUD Kabupaten Simeulue tahun 2018. Penelitian ini meggunakan kualitatif yaitu metode penelitian yang dilakukan dengan tujuan utama untuk membuat gambaran atau deskripsi tentang Faktor keterlambatan pengobatan pada wanita penderita kanker payudara di RSUD Kabupaten Simeulue. Analisis data meliputi pengelolahan data dengan tahapan data reduction, data display, dan conclusion or verificasion. hasil penelitian diperoleh informasi terjadinya keterlambatan pengobatan kanker payudara salah satunya oleh tingkat pendidikan informan, pengentahuan dan fasilitas pengobatan yang kurang lengkap, sehingga mengakibatkan terjadinya keterlambatan dalam penanganan kanker payudara. Sedangakan faktor pendukung keluarga, teman dan petugas kesehatan hanya meyakinkan informan untuk segera mengobati penyakitnya secara tuntas. Faktor keterlambatan pengobatan yaitu pendidikan dan pengetahuan rendah, keterlambatan pengobatan di tempat pengobatan sebelumnya tidak lengkap, faktor keterlambatan pengobatan karena ketiga komponen faktor ini baik keluarga, teman ataupun petugas kesehatan hanya menguatkan informan untuk segera mengobati penyakitnya.

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Race and delays in breast cancer treatment across the care continuum in the Carolina Breast Cancer Study

Understanding the causes of breast cancer treatment delays at a teaching hospital in Ghana.

Poor outcomes for breast cancer in Ghana have been attributed to late presentation of symptoms at biomedical facilities. This study explored factors accounting for delays in initiation of breast cancer treatment at the Korle-Bu Teaching Hospital in Accra. Focus group discussions were conducted with 20 women with breast cancer. A theory-driven thematic analysis identified three multilevel factors influencing treatment seeking delays: (1) patient (e.g. misinterpretation of symptoms, fear), (2) healthcare provider (e.g. negative attitudes) and (3) health systems (e.g. shortage of medicines). Addressing treatment delays will require multilevel interventions, including culturally congruent education, psychosocial counselling/support and strengthening health systems.

Identifying Factors Influencing Delays in Breast Cancer Treatment in Kentucky

Identifying Factors Influencing Delays in Breast Cancer Treatment in Kentucky

Reduction of Breast Cancer Treatment Delay as a Result of Efforts Carried Out by Two Brazilian NGOs

Background: Brazilian breast cancer patients present disease often at advanced stages (III, IV). Previous studies indicated that system delay is a causal factor of bad prognosis and increased mortality rate. In the state of Paraíba, northeast of Brazil, two non-governmental organizations (NGOs) Américas Amigas and Mulheres de Peito de Campina Grande (MLDP), promote faster access to treatment by donating diagnostic mammography and biopsies as well as anatomo-histopathological and immunohistochemical analysis. Aim: The current study aimed at evaluating the effectiveness of the assistance provided by both NGOs and comparing patient flow between HNL and FAP, two reference cancer centers in João Pessoa and Campina Grande, respectively. Methods: Time-to-treatment was analyzed for different time intervals between first medical consultation and initiation of treatment. Comparison was performed between three groups of patients: 40 patients from Hospital Napoleão Laureano (HNL) in João Pessoa; 80 patients from Fundação Assistencial da Paraíba (FAP) in Campina Grande and 15 patients from FAP, who received support from the NGOs. Kaplan-Meier analysis was performed to compare time-intervals among the groups. To estimate the impact of socioeconomic variables Cox regression analysis was performed. Results: Mean time-interval between first medical consultation and hospital admission was 135 (SD=21.0), 370 (SD=73.7) and 515 (SD=36.6) days, for patients of HNL, MLDP and FAP, respectively ( P = 0.0021). Time intervals analyzed for patients within the FAP hospital, between first medical consultation and hospital admission, tended to be shorter for patients who were assisted by the NGOs, compared with those who did not receive any assistance from the NGOs. Patients who had consulted specialized oncological health services beforehand had an increased chance (HZ=2.32; 95% CI: 1.17-4.60; P = 0.016) of being admitted at the reference hospital within 90 days after the first medical consultation, compared with those who had not consulted such specialized services. There were no significant differences between HNL and FAP, regarding the time interval between hospital admission and treatment initiation ( P = 0.21). Conclusion: The assistance to patients provided by the two NGOs, aimed at speeding up the diagnosis process, accelerated patient flow between first medical consultation and admission at the hospitals. Regarding HNL, patients from the inland had been sent by primary health units in their municipalities, directly to the cancer reference hospital in João Pessoa, without being referred to an in-between health service. Such procedure explains the variation of time intervals when admissions at FAP and HNL are compared. The results of the current study indicate that by providing faster breast cancer diagnosis, the NGOs’ mediation can significantly improve patient flow.

Delays on Treatment and Associated Factors in a Cohort of Women Diagnosed With Breast Cancer in Rio De Janeiro, Brazil

Background: The majority of breast cancer death occurs in developing countries. Mortality reductions achieved in the last decades in developed countries have not been reached in developing countries mainly because of a lack of access to early medical attention and delays on treatment. There are very few research studies on the reasons behind delayed medical attention for breast cancer in women in developing countries. Aim: To estimate the treatment delay, and associated factors, among women diagnosed with breast cancer treated on the National Cancer Institute in Rio de Janeiro, Brazil. Methods: A retrospective study on a cohort of 3220 women newly diagnosed with breast cancer between 2011 and 2013 was accomplished. Times from diagnose to treatment initiation were analyzed according to the Brazilian law for cancer patient treatment (≤ 60 > days). Association between sociodemographic, life style, clinical and treatment variables, and delays on treatment were estimated using X2-test and logistic regression model, with 95% confidential interval. Results: Over 50% of women was 50-69 years old, white (50.5%), presented early stage at diagnosis (63.8%), and refereed from public health service (76.9%). From those who had a histopathological diagnosis on the first visit at NCI (N=2,554), median time from diagnose to 1st treatment was 108 days, varying from 97 days (stage T0-2N>1-X/T3-4N0/X) to 133 days (stage Tis). Among those, prevalence of treatment delay was 89.1%; time interval > 30 days from diagnosis and 1st visit at NCI (OR=29.84; CI: 19.80-44.97) and age (50-69: OR=1.61; CI: 1.24-2.11, ≥70 years: OR=1.91; CI: 1.27-2.89) were statistically associated with treatment delay; while high education (OR=0.31; CI: 0.13-0.73) and late stage at diagnosis (OR=0.63; CI: 0.49-0.80) were negatively associate with treatment delay. Among those who arrived without diagnosis (n=666), prevalence of treatment delay was 34.7%. Considering the whole cohort (N=3220) age ≥70 years old (OR=1.42; 1.04-1.94), living outside Rio city (OR=1.53; 1.26-1.87), and chemotherapy (OR=1.44; 1.06-1.95) were positively associated with delay; while college education (OR=0.73; 0.57-0.94) and late stage (OR=0.71; 0.53-0.96) were negatively associated with treatment delay. Conclusion: Increased breast cancer treatment delay was observed among women who arrived with histopathological diagnosis. Time interval from diagnosis on the 1st visit at cancer center was the main factor associated to treatment delay, followed by old age; while high education level and late stage at diagnosis were negatively associated with treatment delays. Considering the whole cohort, old age, living outside Rio and chemotherapy were positively associated to delays on treatment, while college education level and late stage were negatively associated with treatment delay.

Timing and Delays in Breast Cancer Evaluation and Treatment.

Even small delays in the treatment of breast cancer are a frequently expressed concern of patients. Knowledge about this subject is important for clinicians to counsel patients appropriately and realistically, while also optimizing care. Although data and quality measures regarding time to chemotherapy and radiotherapy have been present for some time, data regarding surgical care are more recent and no standard exists. This review was written to discuss our current knowledge about the relationship of treatment times to outcomes. The published medical literature addressing delays and optimal times to treatment was reviewed in the context of our current time-dependent standards for chemotherapy and radiotherapy. The surgical literature and the lack of a time-dependent surgical standard also were discussed, suggesting a possible standard. Risk factors for delay are numerous, and tumor doubling times are both difficult to determine and unhelpful to assess the impact of longer treatment times on outcomes. Evaluation components also have a time cost and are inextricable from the patient's workup. Although the published literature has lack of uniformity, optimal times to each modality are strongly suggested by emerging data, supporting the current quality measures. Times to surgery, chemotherapy, and radiotherapy all have a measurable impact on outcomes, including disease-free survival, disease-specific survival, and overall survival. Delays have less of an impact than often thought but have a measurable impact on outcomes. Optimal times from diagnosis are < 90days for surgery, < 120days for chemotherapy, and, where chemotherapy is administered, < 365days for radiotherapy.

Timeliness of treatment initiation in newly diagnosed breast cancer patients.

e18637Background: Delays in breast cancer treatment lead to poor clinical outcomes. Evidence-based timeliness benchmarks have been established to assess quality of care. However, few studies have e...

Delays in initial breast cancer treatment among black and white women in Boston.

e18620Background: The Boston Breast Cancer Equity Coalition was founded in 2014 to address the persistent mortality gap between black and white women with breast cancer living in Boston. Since dela...

A comprehensive evaluation of breast cancer treatment delays by race among Women's Health Initiative participants.

e18579Background: Breast cancer (BC) mortality is higher in Black vs White women, attributed in some studies to treatment delay. However, prior studies evaluated delay to initial treatment, leaving...

Factors that influence delays in health care seeking, diagnosis and treatment for breast cancer patients in Uganda

Background: Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells, on this noted therefore breast cancer has now become the most commonly diagnosed cancer and the second leading cause of cancer related deaths among women in the Sub- Saharan Africa. The cancer incidence rate of (24%) and 50,000 deaths annually, stated that for the case of Uganda, breast cancer incidence rates almost doubled over the past 20 years. There is limited evidence on the factors which influence health care for breast cancer in Uganda. The purpose of the study was to explore the factors that influenced patient and system-related delays in health seeking, diagnosis and breast cancer treatment in Uganda.

Breast Cancer Diagnosis and Treatment After High-Deductible Insurance Enrollment.

Purpose High-deductible health plans (HDHPs) require substantial out-of-pocket spending and might delay crucial health services. Breast cancer treatment delays of as little as 2 months are associated with adverse outcomes. Methods We used a controlled prepost design with survival analysis to assess timing of breast cancer care events among 273,499 women age 25 to 64 years without evidence of breast cancer before inclusion. Women were included if continuously enrolled for 1 year in a low-deductible ($0 to $500) plan followed by up to 4 years in a HDHP (at least $1,000 deductible) after an employer-mandated switch. Study inclusion was on a rolling basis, and members were followed between 2003 and 2012. The comparison group comprised 2.4 million contemporaneously matched women whose employers offered only low-deductible plans. Measures were times to first diagnostic breast imaging (diagnostic mammogram, breast ultrasound, or breast magnetic resonance imaging), breast biopsy, incident early-stage breast cancer diagnosis, and breast cancer chemotherapy. Outcomes were analyzed by using Cox models and adjusted for age-group, morbidity score, poverty level, US region, index date, and employer size. Results After the index date, HDHP members experienced delays in receipt of diagnostic imaging (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.94 to 0.96), biopsy (aHR, 0.92; 95% CI, 0.89 to 0.95), early-stage breast cancer diagnosis (aHR, 0.83; 0.78 to 0.90), and chemotherapy initiation (aHR, 0.79; 95% CI, 0.72 to 0.86) compared with the control group. Conclusion Women switched to HDHPs experienced delays in diagnostic breast imaging, breast biopsy, early-stage breast cancer diagnosis, and chemotherapy initiation. Additional research should determine whether such delays cause adverse health outcomes, and policymakers should consider selectively reducing out-of-pocket costs for key breast cancer services.

Abstract P4-10-01: Race, place and delays in breast cancer treatment across the care continuum in the Carolina breast cancer study

Abstract Black women have a persistent disparity in breast cancer survival after controlling for clinical factors, suggesting that differential receipt or efficacy of treatment may contribute to poorer outcomes. Delays in initiating treatment and subsequent spillover effects into time to completion are one proposed mechanism by which these survival disparities may occur. The Carolina Breast Cancer Study Phase III is a large population-based study of North Carolina women with incident breast cancer. For this analysis, we included black (n=1328) and white (n=1331) women with stage I-III disease whose treatment included surgery with or without adjuvant therapies. Patients were grouped by treatment pathway (surgery only, surgery + chemotherapy, surgery + radiation, or all three modalities). We investigated the association of race with delays in treatment initiation, duration and completion. Delays in initiation of first treatment were modeled in two ways: i) time to initiation &amp;gt;30 days from diagnosis, and ii) time to initiation above the 75th percentile. Extended duration and delay in completion were defined as being &amp;gt; 75th percentile in days between initiation and end of treatment (duration) or days from diagnosis to end of treatment (completion) compared to others in the same pathway. Models controlled for treatment pathway, age, and tumor characteristics. Additional models controlled for demographic factors (marital status, income, education, insurance) and county-level factors related to care access (% urban and health professional shortage area status). In analyses adjusted only for age at diagnosis, black women had a significantly higher risk of treatment delays whether measured by delay&amp;gt;30 days (risk ratio (RR) 1.24, 95% CI 1.12-1.37) and or by highest quartile of time to initiation (RR 1.23, 95% CI 1.07-1.40) compared to whites. They were also at higher risk of extended treatment duration (RR 1.47, 95% CI 1.29-1.69) and time to completion (RR 1.58, 95% CI 1.37-1.81) compared to others in the same pathway. Interestingly, adjustment for tumor characteristics did not impact effect estimates. While adjustment for demographic factors had little impact on the association of race with delays in initiation, it attenuated the association of race with delays in treatment duration and completion. Further adjustment for care access factors slightly attenuated the association of race with treatment initiation and completion, but did not impact associations with treatment duration. Significant racial disparities remained in delay across all phases of care after adjustment for clinical, demographic and access factors. Overall, black women were at higher risk of delays in treatment initiation, extended duration and time to completion than white women receiving similar treatment, and these disparities appear to be compounded over the care continuum. These findings suggest that racial differences in income, education and insurance may partly explain observed disparities in treatment duration and time to completion, whereas care access factors may have more impact on disparities in treatment initiation, and interventions that target both patient-level and care access barriers may be needed to improve timely delivery across the care continuum. Citation Format: Reeder-Hayes KE, Mayer SE, Olshan A, Carey LA, Wheeler SB, Tse C-K, Troester M. Race, place and delays in breast cancer treatment across the care continuum in the Carolina breast cancer study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-01.

Abstract P4-10-15: Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas

Abstract Background: Access to medical care vary across the world and is related to different health systems with an impact in recurrence.Objective: To evaluate disparities in breast cancer(BC) diagnosis and treatment between public and private services in southwest Brazil and at two public safety net hospitals in Houston, Texas.Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at the four hospitals in Brazil and two health centers in US were included. All statistical analyses were performed in R studio software, and p&amp;lt;0.05 was considered significant.Results: 1245 women were included: 967 from public health system (PHS) (20.3% from Houston, Texas) and 274 from private system(PS). Recurrence rate was higher in PHS (14.6% vs. 2.6%, p&amp;lt;0.001) Table 1. Clinical and demographic characteristics of the patientsCharacteristicsPublic (%), n=967Private (%), n=274pDiscovery of BC By patient530 (54.8)92 (33.5) Routine exam87 (9)109 (39.8) Screening mammography270 (27.9)23 (8.4) Other80 (8.3)50 (18.3)&amp;lt;0.001Initial treatment Surgery687 (71)241 (88) Neo-adjuvant chemotherapy224 (23.2)27 (9.8) Neo-adjuvant hormone therapy23 (2.3)27 (9.8) Not available33 (3.4)3 (1.1)&amp;lt;0.001Clinical Stage I293 (30.3)113 (41.2) II342 (35.4)52 (19) III271 (28)15 (5.5) Unknown61 (6.3)94 (34.3)&amp;lt;0.001Subtype HR+/HER2 -561 (58)192 (70.1) HR-/HER2+108 (11.1)29 (10.6) HR-/HER2+76 (7.9)14 (5.1) Triple negative149 (15.4)28 (10.2) Unknown73 (7.6)11 (4)0.012Symptomatic at Diagnosis Yes591 (61.1)100 (36.5) No306 (31.6)97 (35.4) Unknown70 (7.2)77 (28.1)&amp;lt;0.001Recurencen=772n=146 No719 (74.4)193 (70.4) Yes142 (14.6)7 (2.6) Unknown106 (11)74 (27)&amp;lt;0.001 . Considering the interval in weeks: symptoms to diagnosis, diagnosis to first treatment (either surgery or neoadjuvant chemotherapy), diagnosis to first systemic treatment, diagnosis to surgical treatment and diagnosis to radiotherapy were longer in public patients (24.1 vs. 8.7; 11.1 vs. 3.5; 18.6 vs. 9.8; 16.9 vs. 5.6; 51.4 vs. 26.1; p&amp;lt;0.001). Table 2. Delay disparities between public and private health system PublicPrivatepSymptoms to diagnosis Number of patients575146 Time (weeks)24.1 (0.4-104.9)8.7 (0.0-43.7)&amp;lt;0.001Diagnosis to first treatment Number of patients663180 Time (weeks)11.1 (2.0-31.5)3.5 (0.0-11.0)&amp;lt;0.001Diagnosis to first systemic treatment Number of patients526106 Time (weeks)18.6 (2.6-44.7)9.8 (1.9-29.3)&amp;lt;0.001Diagnosis to surgical treatment Number of patients657178 Time (weeks)16.9 (3.4-45.6)5.6 (0.0-32.9)&amp;lt;0.001Diagnosis to radiotherapy Number of patients465127 Time (weeks)51.4 (18.7-88.4)26.1 (5.6-66.4)&amp;lt;0.001 In multivariate analysis, PHS (HR 1.72; 95% CI 1.34-1.88; p adj=0.003), presence of symptoms (HR 2.29; 95% CI 1.39-3.78; p adj=0.001), clinical stage III (HR 1.62; 95% CI 1.35-1.93; p adj&amp;lt;0.001), and triple negativity and HER2neu positivity (1.18; 95% CI 1.03-1.35; p adj=0.021) were all associated with a higher recurrence rate.Conclusions: There were significant disparities between PHS and PS. Women in the PHS presented higher rates of recurrence, advanced clinical stages at diagnosis, symptoms and more aggressive subtypes by IHC. additionally, the interval between symptoms to diagnosis and diagnosis to treatments was longer in PHS. Citation Format: NematiShafaee M, Natal RA, Ramalho S, Dória MT, Conz L, Cabello V, Pavanello M, Mano MS, Linck RDM, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Bondy ML, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, Cabello C. Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-15.

Abstract P4-10-16: Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US

Abstract Background: Delays in diagnosis and treatment is associated with recurrence. Access to medical care in public health systems (PHS) may vary across Southwest Brazil and Houston, Texas. Objective: To evaluate disparities in breast cancer (BC) diagnosis and treatment between public services in southwest Brazil and at a public safety net hospital in Houston, Texas. Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at thefour hospitals in Brazil and two health centers in US were included. All statistical analyses was performed in R studio, and p&amp;lt;0.05 was considered significant. Results: 967 women from PHS were included: 778 from Brazil and 189 from US. Recurrence rates were not significantly different (15.9% vs. 9.5%, p=0.233) Table 1. Clinical and demographic characteristics of the patientsCharacteristicsBrazil (%), n=778US (%), n=189pDiscovery of BC By patient443 (56.9)87 (46) Routine exam82 (10.5)5 (2.7) Screening mammography207 (26.6)63 (33.4) Other46 (6)34 (17.9)&amp;lt;0.001Initial treatment Surgery587 (75.4)100 (52.9) Neo-adjuvant chemotherapy176 (22.6)48 (25.4) Neo-adjuvant hormone therapy9 (1.1)14 (7.4) Unknown6 (0.9)27 (14.3)&amp;lt;0.001Clinical Stage I234 (30.1)59 (31.2) II289 (36.8)56 (29.7) III239 (30.7)32 (16.9) Unknown19 (2.4)42 (22.2)0.027IHQ Subtype HR+/HER2 -467 (60)94 (49.7) HR+/HER2+91 (11.7)17 (9) HR-/HER2+66 (8.5)10 (5.3) Triple negative123 (15.8)26 (13.8) Unknown31 (4)42 (22.2)0.853Symptoms Yes492 (63.2)99 (52.4) No248 (31.9)58 (30.7) Unknown38 (4.9)32 (16.9)0.410Recurence No599 (77)120 (63.5) Yes124 (15.9)18 (9.5) Unknown55 (7.1)51 (27.0)0.233 . Considering the interval in weeks: symptoms to diagnosis, diagnosis to first systemic therapy and diagnosis to radiotherapy were longer in Brazil PHS patients (24.4 vs. 22.8; 18.9 vs. 16.1 and 51.8 vs. 47.8 p&amp;lt;0.001). Table 2. Delay disparities in public health system between Brazil and US BrazilUSpSymptoms to diagnosis Number of patients473102 Time (weeks)24.4 (0.5-102.6)22.8 (0.1-124.8)&amp;lt;0.001Diagnosis to first treatment Number of patients546117 Time (weeks)10.8 (1.9-31.7)12.2 (3.1-26.4)&amp;lt;0.001Diagnosis to first systemic treatment Number of patients45967 Time (weeks)18.9 (2.4-45.6)16.1 (3.3-38.6)&amp;lt;0.001Diagnosis to surgical treatment Number of patients541116 Time (weeks)16.4 (3.1-43.1)19.2 (4.5-51.2)&amp;lt;0.001Diagnosis to radiotherapy Number of patients41352 Time (weeks)51.8 (19.4-89.7)47.8 (14.9-84.8)&amp;lt;0.001 However, considering the interval in weeks: diagnosis to first treatment (either surgery or neoadjuvant chemotherapy) and diagnosis to surgical treatment were shorter in Brazil PHS patients (10.8 vs. 12.2 and 16.4 vs. 19.2, p&amp;lt;0.001). When considering surgery as initial treatment, treatment in Brazil PHS and stage III disease at diagnosis were associated with worse prognosis (HR: 1.91, 95%CI: 1.38 – 1.99, padj=0.015; HR 1.44, 95%CI:1.11-1.87, padj=0.006). Conclusions: There were significant disparities between Brazil and US PHS. Women in Brazil PHS presented higher rates of advanced clinical stages at diagnosis and diagnosis by routine exam, while US PHS present higher rates of diagnosis by screening mammography. When considering surgery as initial treatment, Houston PHS women had a better prognosis. Citation Format: Ramalho S, Dória MT, Natal RA, Conz L, Cabello V, Pavanello M, Cabello C, Mano MS, Linck RD, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, NematiShafaee M, Bondy ML. Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-16.

Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan

Objective:Although Kazakhstan has made significant investments to improve health and life expectancy of its population, high cancer rates persist, with breast cancer being the most prevalent type. Factors contributing to delays in treatment and late staging for breast cancer patients were assessed.Methods:A retrospective follow-up study with registry data identified 4,248 breast cancer patients in sixteen regions of Kazakhstan in 2014. We used logistic regressions to estimate (i) associations of treatment delays with patient demographics and cancer center regions; and (ii) associations of late-stage (III and IV) cancer diagnosis with patient demographics and cancer center regions, with and without controlling for treatment delays.Results:Breast cancer patients treated in regions located further away from Almaty City had higher risks of treatment delays. However, the risks of late-stage cancer diagnosis were greater for patients treated in Almaty City and those with treatment delays.Conclusion:The main driver of delayed treatment is cancer center region. Residents of Almaty City, a major urban area of Kazakhstan, may have a better access to a tertiary cancer center, resulting in less treatment delays. Referrals of sicker patients from neighboring regions to Almaty City for cancer treatment is likely to increase risks of late-stage diagnosis. New or upgraded cancer centers may reduce treatment delays, but their case-mix is likely to increase.