Black Patients With Breast Cancer May Face Longer Waits, Treatment Duration

Black patients with breast cancer encounter longer waits for treatment initiation and prolonged duration of treatment compared with white women, according to findings of an analysis published online in Cancer.¹ Both limitations are potential contributors to the racial disparity seen in breast cancer mortality.

Although Black women and White women face similar rates of breast cancer occurrence, past research has shown that breast cancer death rates are about 40% higher in Black women, and cancer is more likely to be caught at an earlier stage in White women.² The recent analysis assessed groups of women with similar socioeconomic status (SES), access to care, and tumor characteristics to evaluate time to treatment and treatment duration trends by age and race.

Researchers identified 2841 patients (about half Black women and half White) using the Carolina Breast Cancer Study Phase 3 (CBCS3), which aims to find out how Black and White women’s breast cancer causes, treatments, and long-term outcomes differ. They limited the analysis to participants with stage I to III breast cancer because metastatic disease management occurs on a different clinical pathway compared with localized disease.

They found that Black women had more delays in the start of treatment than White women (13.4% vs 7.9%), defined as initiation more than 60 days after diagnosis. The overall median time before the start of treatment was 34 days.

Black women at both the low- and high-SES levels (14.4% and 11.7%, respectively) saw delays in treatment initiation. On the other hand, just 10.6% of White women in the low SES group and 6.7% in the high SES group had delays.

“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,” lead author Marc Emerson, PhD, University of North Carolina Chapel Hill, said in a statement.³

Black women also saw higher rates of prolonged treatment duration (29.9% vs 21.1%), which was defined differently across treatment modalities. For radiation, it was more than 56 days between the date of first and last treatments; definitive surgery, more than 74 days; and chemotherapy, more than 119 days.

Both race and SES were significantly associated with extended treatment duration more so than with delays in the start of treatment, but there was still a disparity between Black women and White women. White, low-SES women saw higher rates of prolonged treatment duration than the high-SES cohort (26.2% vs 18.7%, respectively). In Black women, 32.9% in the low-SES group saw prolonged treatment duration vs 24.9% in the high-SES cohort.

There was also a pronounced disparity when the groups were stratified by race and age. Younger Black women were more likely to face prolonged treatment duration than younger White women (32% vs 22.3%, respectively). In older women, 27.9% of Black patients had longer treatment duration, as opposed to 19.9% of White patients.

Black women with more barriers to care also had a significant rate of prolonged treatment duration (42.6% vs 28% in Black women with fewer barriers to care). The authors noted that that longer treatment duration may compound across the continuum of care, making it a sensitive marker for access to care disparities.

“It is important to recognize that the causes of delay are complex and reflect both individual barriers and system level factors,” study author Melissa Troester, PhD, of the University of North Carolina at Chapel Hill, said.

Authors noted that the analysis had some limitations, including that they could not evaluate the long-term implications of prolonged treatment in regard to survival or recurrence. CBCS3 also ended recruitment in 2013 and currently has a median follow-up period of 7 years, meaning it is not mature enough to gauge the association between treatment timeliness and long-term mortality.

They concluded that treatment delay is a complex, multifaceted issue and that barriers to care, both economic and logistical, appear to compound over the course of treatment. But the identification of the specific factors that contribute to racial disparities would help researchers figure out what interventions can reduce the breast cancer mortality disparity between Black and White patients.

References

1. Emerson MA, Golightly YM, Aiello AE, et al. Breast cancer treatment delays by socioeconomic and health care access latent classes in Black and White women. Cancer. Published online September 21, 2020. doi:10.1002/cncr.33121

2. Breast cancer rates among Black women and White women. CDC. Updated September 12, 2018. Accessed November 2, 2020. https://www.cdc.gov/cancer/dcpc/research/articles/breast_cancer_rates_women.htm​

3. Black women may be less likely to receive timely treatment for breast cancer. News release. Wiley. Accessed November 2, 2020. https://newsroom.wiley.com/press-releases/press-release-details/2020/Black-Women-May-Be-Less-Likely-to-Receive-Timely-Treatment-for-Breast-Cancer/default.aspx