N. M. Zaremba1, M. Martin1, A. T. Davis1, P. Haan1, H. L. Bumpers1 1Michigan State University,Department Of Surgery,Lansing, MI, USA
Introduction: It is well known that breast cancer mortality is higher in African American (AA) and young women than in White and older women. This disparity has been attributed to delayed diagnosis, treatment, and follow-up of breast abnormalities. Neither age nor race have been shown to be independent risks for delayed diagnosis or treatment, but socioeconomic status supplants race in some studies. AA women present younger and with later stage disease compared to Whites. Precise factors accounting for these delays have not been defined. This is Phase I of a multi-institutional study to identify risk factors for delays in diagnosis and treatment. Phase II will compare with a large metropolitan hospital caring for the underserved.
Methods: A retrospective chart review of 107 consecutive patients with a diagnosis of DCIS or invasive breast cancer was performed at a single Midwestern institution where the majority of patients are White and middle class. Delayed diagnosis was defined as 60 days or greater from sign/symptom onset to biopsy and delayed treatment was 60 days or more from tissue diagnosis to first treatment (surgery or neoadjuvant therapy). Income estimates were based on zip code and 2010 US Census. Univariate analysis was performed. This study was approved by the Michigan State University Institutional Review Board.
Results: Age ranged from 24 to 91 years. Fifteen (14.0%) patients had delayed diagnosis and 10 (9.3%) had delayed treatment. Patients without a family history of cancer had higher risk for diagnostic delay, RR 5.4 (95% CI 1.9-15.8), than patients with a family history of cancer, p =0.001. Similarly, patients without a family history of breast cancer had higher risk for delayed diagnosis, RR 6.9 (95% CI 1.6-29.0) than patients with a family history of breast cancer, p =0.001. As expected, palpable masses and large tumors (T3-4) were associated with delayed diagnosis, RR 4.7 (95% CI 1.4-15.8), p = 0.004 and RR 4.4 (95% CI 1.8-10.7), p =0.014, respectively. Advanced stages (III-IV) were also associated with diagnostic delays, RR 3.1 (95% CI 1.2-8.1), p =0.049. Those with a lower estimated income had significantly delayed treatment, RR 3.8 (95% CI 1.03-13.7), p =0.042. On univariate analysis, none of the following parameters were significantly associated with a delay in diagnosis or treatment: age, race, insurance status, marital status, employment, smoking, menopausal status, or HRT. Diagnostic delays were also due to patients (fear of physicians, misconceptions about cure with healthy lifestyle, personal issues) and physicians (low suspicion, inconclusive imaging, need for medical intervention prior to treatment).
Conclusion: This group of patients had little delay in diagnosis and treatment. The individual parameters significantly associated with delayed diagnosis and treatment were lack of family history of breast cancer or any cancer, and lower estimated household income. Phase II of this study will be done for comparisons.