Could Race Delay, Extend Breast Cancer Treatment?

A new study published in the journal Cancer evaluated disparities in the delay and duration of breast cancer treatment based on a patient’s race. The researchers found that black women tend to have delayed treatment initiation and receive treatment longer than white women who are receiving similar treatment.

“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,” the study authors wrote.

The study evaluated women in phase three of the Carolina Breast Cancer Study, which included a population-based cohort of women with incident breast cancer. The present study included 1,328 black women and 1,331 white women with stage one to stage three breast cancer. Patients eligible for inclusion had underwent surgery with or without adjuvant therapies. Adjusted analyses were performed controlling for treatment pathway, age, and tumor characteristics as well as demographic factors pertaining to health care access. “A novel treatment pathway grouping was used to benchmark the treatment duration (surgery only, surgery plus chemotherapy, surgery plus radiation, or all 3),” the researchers also added.

Adjusted analyses found that black patients, compared to white patients, were significantly more likely to initiate their treatment more than 60 days after their diagnosis (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.04‐2.90). Black patients had longer treatment duration, and had a higher risk to be in the highest quartile of treatment duration (OR, 1.69; 95% CI, 1.41‐2.02); the association remained when adjusting for demographic and tumor characteristics (OR, 1.31; 95% CI, 1.04‐1.64). Patients had a higher risk for recurrence if they had delayed initiation (hazard ratio [HR], 1.44; 95% CI, 0.89‐2.33) or the longest duration (HR, 1.17; 95% CI, 0.87‐1.59), although researchers said this trend was not significant.

“Black women more often had delayed treatment initiation and a longer duration than whites receiving similar treatment,” the researchers wrote in sum. “Interventions that target access barriers may be needed to improve timely delivery of care.”