Impact of race and health insurance on delays in breast cancer diagnosis and treatment in the District of Columbia

Researchers at The George Washington Cancer Institute, with funding from the National Cancer Institute, examined the effect of race and health insurance status on diagnostic and treatment delays over a 12-year period.

"We thought having health insurance would even the field. Insured black women should have had the same rapid evaluation as insured white women, but that was not the case in our study," said Heather Hoffman, Ph.D., assistant professor of epidemiology and biostatistics at The George Washington University School of Public Health and Health Services.

Hoffman and colleagues conducted a retrospective, cohort study of 581 women with breast cancer. Women were examined between 1997 and 2009 at seven hospitals and clinics in Washington, D.C.

Diagnostic delay time was defined as the number of days from abnormal screening to diagnosis, and treatment delay time was defined as the number of days from diagnosis to treatment initiation.

According to Hoffman, the goal was to identify risk factors associated with delays in diagnosis. They found the following:

• insured black women and uninsured white women waited more than twice as long to reach their definitive diagnosis than insured white women;
• lack of health insurance decreased the speed of diagnosis in white women, but having insurance did not increase the speed of diagnosis in black women; and
• overall, black women waited twice as long as white women for treatment initiation following definitive diagnosis.

Based on the results of this study, the researchers suggested that outreach focus on all black women and uninsured white women to improve their diagnostic time, and the importance of medical follow-up should be explained to patients.

"Black women should be the focus of breast cancer screening outreach and follow-up because they experience greater delays in diagnosis and in treatment than white women, regardless of insurance status," said Hoffman. "We need to determine those barriers in insured black women and all uninsured women."

This research was recently presented at the American Association for Cancer Research 101st Annual Meeting 2010.