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Treatment Delay Longer for Young African-American Women

January 23, 2014

Written By Robin Warshaw, Contributing Writer
Reviewed By Kimlin Ashing, PhD

African-American women, ages 20 to 49, experience a much greater delay in treatment for breast cancer — for varying reasons — than do White women of the same ages, according to a North Carolina study.

The study was published in Cancer Epidemiology, Biomarkers & Prevention.

Background and Reason for the Study

Deaths from breast cancer are higher among African-American women than White women. This may be due, in part, to delays in detection and from the time of diagnosis to the start of treatment.

Most studies show that African-American women experience delays in treatment for breast cancer more often than do White women. This gap exists even when women have similar economic or health characteristics.

The researchers of this study wanted to better understand the factors influencing treatment delay and to determine racial differences in delay among North Carolinian women diagnosed with breast cancer.

Study Structure

Investigators gathered data from medical records for the study, which is part of the ongoing Carolina Breast Cancer Study. They also obtained information directly from women through a questionnaire and an interview with a nurse.

The 601 women in the study were

  • 20 to 74 years old
  • residents of North Carolina when diagnosed
  • African-American or White
  • treated initially with surgery or neoadjuvant (given before surgery) chemotherapy or hormonal therapy

Treatment delay was defined as more than 30 days after diagnosis.

Factors considered that might cause delay included: demographics, socioeconomics, healthcare access, clinical reasons and emotional or functional well-being.

Findings

White women between the ages of 20 and 49 had a low likelihood of experiencing delays in treatment. African-American women in the same age range were more than 3 times as likely to have a delay. This difference in time to treatment between African-American and White women did not appear in women ages 50 and older. 

Overall, delay in treatment was significantly associated with women who had

  • households of 3 or fewer people
    • this may signify less social and practical support
  • lost a job due to diagnosis
    • African-American women were more likely to lose a job due to diagnosis
    • job loss may mean loss of private, employer-based insurance, which could cause delay; White women were more likely to have private insurance
  • immediate reconstruction after mastectomy
    • the time taken to coordinate the schedules of both the plastic surgeon and breast surgeon might explain this delay

The factors most often associated with treatment delay among African-American women were

  • immediate reconstruction
    • African-American women were less likely than white women to have this procedure, but nearly all (> 90 percent) experienced a delay in initial treatment

and

  • first treatment type
    • mastectomy – 58.2 percent of women had a delay
    • breast-conserving therapy (lumpectomy) – 33.6 percent of women had a delay
    • neoadjuvant therapy – 51.2 percent of women had a delay

What This Means for You

When you receive a breast cancer diagnosis, you may feel anxious to start treatment right away. On the other hand, you may want time to think about treatment options, consult another doctor for a second opinion, or make plans for work and family duties.

Having treatment on time is important. Talk with your doctor and healthcare team about how much time it will take until treatment begins. Find out about your insurance coverage and other financial concerns right away, to minimize delay. Get a second opinion promptly. In general, you should agree on a care plan and begin treatment within 3 to 4 weeks of a diagnosis. Best practice suggests that waiting 4 weeks or more is considered a delay in treatment.

If you are an African-American woman under age 50, you may be more likely to experience treatment delay. An oncology social worker or another member of your healthcare team can help you avoid problems that may cause delay.

You may find answers to many of your questions in LBBC’s Guide for the Newly Diagnosed.  

McGee, SA, Durham, DD, Tse, CK et al. Determinants of breast cancer treatment delay differ for African American and white women. Cancer Epidemiology, Biomarkers & Prevention. 2013; doi: 10.1158/1055-9965.EPI-12-1432.  

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Denver, CO  ·  September 13, 2014

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