Study results published in the early online edition of CANCER, a peer-reviewed journal of the American Cancer Society (ACS), suggest that black women experience longer waits for treatment initiation than white women after a breast cancer diagnosis. In addition, the study shows that the duration of treatment is prolonged.[1]

Previous research has shown that black women face a higher risk of dying from breast cancer than white women despite similar rates of breast cancer occurrence, and this disparity is especially high among younger women. A team led by Melissa A. Troester, Ph.D., of the University of North Carolina at Chapel Hill (UNC) and UNC Lineberger Comprehensive Cancer Center evaluated whether two aspects of care—time to treatment and duration of treatment—may be contributing factors.

Carolina Breast Cancer Study
The investigators’ analysis included 2,841 participants (roughly equal numbers of Black and white women) with stage I-III breast cancer in the Carolina Breast Cancer Study, a population-based study of women with invasive breast cancer.

The study, conducted by the Lineberger Comprehensive Cancer Center in affiliation with the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, is funded in part by the University Cancer Research Fund, the National Cancer Institute‘s Specialized Program of Research Excellence (SPORE) in breast cancer, and Susan G. Komen For the Cure.

Delayed time to treatment
The overall median time to treatment initiation was 34 days. More Black women experienced a delayed time to treatment (13.4% versus 7.9%) and a prolonged duration of treatment (29.9% versus 21.1%) compared with white women.

This delay is, according to some experts, concerning, since current recommendations urge starting treatment as soon as possible after diagnosis. Furthermore, timely treatment reduces the risk that cancer metastasizes and increases the chances of survival. Unrelated and earlier studies have demonstrated that delaying surgery by 30 days and chemotherapy by 90 days can lead to worse survival.[2][3][4]

Treatment duration
Thirty-two percent of young Black women were in the highest quartile of treatment duration, compared with 22.3% of younger white women; similarly, 27.9% of older Black women experienced prolonged treatment duration compared with 19.9% of older white women.

Also, among women with high socioeconomic status, 11.7% of Black women experienced delays in initiating treatment compared with 6.7% of white women.

“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,” said lead author Marc Emerson, Ph.D.

“It is important to recognize that the causes of delay are complex and reflect both individual barriers and system-level factors,” Troester added. The study identified a number of specific barriers, including financial and transportation issues.

Cancer health disparities
Cancer health disparities are an enormous public health challenge with racial and ethnic minority populations among those that have long experienced disparities in the diagnosis and treatment of cancer, which, in a broader sense, also includes hematological malignancies. [5][6]

Numerous studies have exposed how preventable cancer risk factors, rates of cancer screening for early detection, receipt of the standard of care cancer treatment, and the burden of adverse effects of cancer and cancer treatment persist for racial and ethnic minorities and other underserved populations.[5]

The study results published today in CANCER, follow the release, last week, of the American Association for Cancer Research (AACR) inaugural Cancer Disparities Progress Report 2020: Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations.[1][5]

The AACR report was designed to help the public’s understanding of cancer health disparities and the vital importance of research to saving lives. It also emphasizes the vital need for continued transformative research and for increased collaboration among all stakeholders working toward a bold vision of health equity.

The report specifically underscores the need for increased federal funding for the government entities that fuel progress against cancer health disparities.

Reference
[1] Emerson MA, Golightly YM, Aiello AE, Reeder-Hayes KE, Tan X, Maduekwe U, Johnson-Thompson M, Olshan AF, Troester MA. 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). [Article]
[2] Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer. JAMA Oncol. 2016;2(3):322–329. doi:10.1001/jamaoncol.2015.3856
[3] Biagi  JJ, Raphael  M, King  WD, Kong  W, Booth  CM, Mackillop  WJ.  The effect of delay in time to adjuvant chemotherapy (TTAC) on survival in breast cancer (BC): A systematic review and meta-analysis.ASCO Meeting Abstracts. June 9, 2011 2011;29(15_suppl):1128.
[4] Yu KD, Huang S, Zhang JX, Liu GY, Shao ZM. Association between delayed initiation of adjuvant CMF or anthracycline-based chemotherapy and survival in breast cancer: a systematic review and meta-analysis. BMC Cancer. 2013;13:240. Published 2013 May 16. doi:10.1186/1471-2407-13-240
[5] Cancer Disparities Progress Report. Philadelphia: American Association for Cancer Research;© September 2020. Available Online.  Last accessed on September 14, 2020. [Report]
[6] Hofland, P. Addressing Disparities in Cancer: Factors Influencing Care, Access, and Outcomes. Onco’Zine. Online. Last accessed on September 14, 2020.

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