Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Dubin Breast Center, Tisch Cancer Institute, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ann Surg Oncol. 2022 Oct;29(11):6692-6703. doi: 10.1245/s10434-022-11971-w. Epub 2022 Jun 13.
Racial disparities in breast cancer care have been linked to treatment delays. We explored whether receiving care at a comprehensive breast center could mitigate disparities in time to treatment.
Retrospective chart review identified breast cancer patients who underwent surgery from 2012 to 2018 at a comprehensive breast center. Time-to-treatment intervals were compared among self-identified racial and ethnic groups by negative binomial regression models.
Overall, 2094 women met the inclusion criteria: 1242 (59%) White, 262 (13%) Black, 302 (14%) Hispanic, 105 (5%) Asian, and 183 (9%) other race or ethnicity. Black and Hispanic patients more often had Medicaid insurance, higher American Society of Anesthesiologists (ASA) scores, advanced-stage breast cancer, mastectomy, and additional imaging after breast center presentation (p < 0.05). After controlling for other variables, racial or ethnic minority groups had consistently longer intervals to treatment, with Black women experiencing the greatest disparity (incidence rate ratio 1.42). Time from initial comprehensive breast center visit to treatment was also significantly shorter in White patients versus non-White patients (p < 0.0001). Black race, Medicaid insurance/being uninsured, older age, earlier stage, higher ASA score, undergoing mastectomy, having reconstruction, and requiring additional pretreatment work-up were associated with a longer time from initial visit at the comprehensive breast center to treatment on multivariable analysis (p < 0.05).
Racial or ethnic minority groups have significant delays in treatment even when receiving care at a comprehensive breast center. Influential factors include insurance delays and necessity of additional pretreatment work-up. Specific policies are needed to address system barriers in treatment access.
乳腺癌治疗中的种族差异与治疗延迟有关。我们探讨了在综合性乳腺癌中心接受治疗是否可以减轻治疗时间方面的差异。
回顾性病历审查确定了 2012 年至 2018 年在综合性乳腺癌中心接受手术的乳腺癌患者。通过负二项回归模型比较了自我认同的种族和族裔群体之间的治疗时间间隔。
共有 2094 名女性符合纳入标准：1242 名（59%）白人、262 名（13%）黑人、302 名（14%）西班牙裔、105 名（5%）亚洲人和 183 名（9%）其他种族或族裔。黑人患者和西班牙裔患者更常拥有医疗补助保险、更高的美国麻醉师协会（ASA）评分、晚期乳腺癌、乳房切除术和乳房中心就诊后进行额外的影像学检查（p<0.05）。在控制其他变量后，少数族裔群体的治疗时间间隔始终较长，黑人女性的差异最大（发病率比 1.42）。从初次综合性乳腺癌中心就诊到治疗的时间也明显短于非白人患者（p<0.0001）。黑人种族、医疗补助保险/无保险、年龄较大、较早的分期、较高的 ASA 评分、接受乳房切除术、进行重建以及需要额外的预处理检查与从初次就诊到综合乳房中心治疗的时间延长在多变量分析中相关（p<0.05）。
即使在综合性乳腺癌中心接受治疗，少数族裔群体的治疗也存在显著延迟。有影响力的因素包括保险延迟和额外预处理检查的必要性。需要制定具体政策来解决治疗机会方面的系统障碍。
