Black Women with Breast Cancer Experience More Treatment Delays, Prolonged Treatment Duration Compared With White Women

November 30, 2020
Darlene Dobkowski, MA

Several factors may lead to prolonged treatment duration for breast cancer including socioeconomic status, race, and barriers to care.

Black women were more likely to experience delayed treatment and prolonged treatment duration compared with white women, regardless of socioeconomic status, according to a study published in Cancer.

“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 Marc A. Emerson, PhD, MPH, postdoctoral fellow in the department of epidemiology at the University of North Carolina at Chapel Hill Gillings School of Global Public Health and lead author of the study, in a press release.

Despite similar incidence rates of breast cancer in white and Black women, the breast cancer mortality rate is 42% higher in Black women, especially in those younger than 45 years old. Several factors may play a role in these mortality differences, including screening tools and screening guidelines, more adverse tumor biology and later stage at diagnosis.

Study authors assessed time to treatment and treatment duration as possible contributors to these disparities by analyzing data from 2841 participants from the Carolina Breast Cancer Study Phase 3, a population-based cohort study with women diagnosed with invasive breast cancer, which was defined as stage I to III.

Participants were grouped by similar patterns of access to care, tumor characteristics, and socioeconomic status, which included income and education. This information was used to evaluate treatment delay, defined as initiating treatment more than 60 days after diagnosis, and treatment duration, which was assessed by treatment type, including radiation therapy, surgery, and chemotherapy.

There were two outcomes of interest that reflected treatment delay: delay in the start of treatment and prolonged treatment duration. Treatment initiation was defined as the number of days between breast cancer diagnosis and the first day of treatment, while treatment duration was the number of days between the first and last day of treatment.

Increased treatment duration was observed more in younger Black women compared with younger white women (32% vs. 22.3%). Black women were also more likely to have delayed treatment initiation and prolonged treatment duration compared with white women.

White women with low socioeconomic status were more likely to experience treatment delay. In contrast, treatment delay in Black women was observed in all levels of socioeconomic status. For example, treatment delay occurred in 11.7% of Black women with high socioeconomic status compared with 10.6% in white women with low socioeconomic status and 6.7% in white women with high socioeconomic status.

While access to care and socioeconomic status did not significantly affect delayed treatment initiation in Black women, increased barriers and low socioeconomic status were linked with longer treatment duration in both white and Black women.

“We hypothesize that the workload associated with breast cancer care is experienced differently by different populations, depending on [socioeconomic status] and other factors, and that treatment paths that include radiation therapy are particularly sensitive to these differences because radiation requires multiple visits within a short period,” the study authors wrote. “Future efforts aim at developing measures of workload in this population to directly test this hypothesis.”

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