Breast cancer diagnostic delay depends more on race than insurance, study finds

Heather J. Hoffman, Ph.D., assistant professor of epidemiology and biostatistics at George Washington University School of Public Health and Health Services, and colleagues at the George Washington Cancer Institute, conducted a retrospective cohort study of 983 women examined for breast cancer between 1998 to 2009 at six hospitals and clinics in Washington, D.C.

Findings revealed that non-Hispanic black and Hispanic women with government or private insurance waited more than twice as long for a definitive diagnosis than non-Hispanic white women with government or private insurance.

Diagnostic delay time, or the amount of time between when abnormalities were found until a diagnosis was reached, for uninsured black women was more than twice as long as that of black women with private insurance. Although having private insurance reduced time to diagnosis for black women, they still waited significantly longer for a diagnosis than white women with private insurance.

"We were surprised by the fact that non-Hispanic black and Hispanic women with health insurance experienced greater delays than non-Hispanic white women with health insurance," Hoffman said. "We thought having health insurance would even the field among all women. Insured women should have had the same rapid evaluation regardless of race and ethnicity."

Among those with private insurance, diagnostic delay time, or the number of days from abnormal screening to definitive diagnosis, was 15.9 days for white women, 27.1 days for black women and 51.4 days for Hispanic women. Diagnostic delay times among those with government insurance were 11.9 days for white women, 39.4 days for black women and 70.8 days for Hispanic women. Finally, among those without insurance, diagnostic delay times were reported as 44.5 days for white women, 59.7 days for black women and 66.5 days for Hispanic women.

"Non-Hispanic black and Hispanic women should be the focus of breast cancer screening outreach and follow-up since they experience greater delays in diagnosis than non-Hispanic white women, regardless of type of insurance," Hoffman said. "In particular, we need to investigate the barriers to rapid workup in insured non-Hispanic black and Hispanic women first and then investigate barriers in all uninsured women."

"Health care professionals must stress follow-up with all non-Hispanic black and Hispanic women with breast abnormalities to assure they are diagnosed as soon as possible," she added.

This work was conducted as part of the George Washington Cancer Institute's involvement with the NCI-funded national Patient Navigation Research Program, which is designed to assess whether patient navigation can reduce the time between diagnostic finding and resolution and time between diagnosis and treatment.