L. Steel1, Y. R. Li1, E. Carrigan1, J. Tchou1 1University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction: Prompt and appropriate surgical management following diagnosis significantly impacts long-term survival in breast cancer patients. However, access to care can often be delayed. Some studies have observed that there are racial discrepancies in the length of time between initial cancer diagnosis and definitive cancer surgery, and race has been repeatedly shown to be an independent predictor of survival.
Methods: To test the hypothesis that the length of time between breast cancer diagnosis and definitive surgery is associated with race, we performed a retrospective chart review of a pilot breast cancer patient cohort (n=424) who have received their surgical care at a single institution between 1995 and 2015 to establish feasibility. Women were stratified into the following categories based on self-reported race: Asian (16), Black (112), White (283), and Other (9). The interval from cancer diagnosis to definitive cancer surgery was defined as the number of days from the date of the patient’s initial positive core biopsy or surgical biopsy to the date of definitive surgical intervention (i.e., lumpectomy or mastectomy).
Results: The average diagnosis to surgery time was the longest for African Americans (65.29 days, median = 42) and significantly shorter for White women (49.76 days, median = 34) (two-sided t-test p <0.008). Asians (48.56 days, median = 35.5) and patients of other ethnicities (52.33 days, median =39.92) had comparable diagnosis to surgery times as compared to White women, though their cohort sizes were small and precluded statistical analysis.
Conclusion: Our findings are consistent with other studies showing that there is a prolonged diagnosis to surgery time for women of African American descent. It is not clear whether this is due to delays in seeking care after diagnosis or if there are delays in scheduling surgery. Socioeconomic and cultural differences as well as disparities in health literacy and education may all contribute to these differences. Further analysis is planned to expand our pilot cohort to include more than 3,000 patients consecutively treated at our institution during this study period to evaluate the impact of other covariates, which are not commonly available in national databases but are readily available from our electronic medical record, on the relationship between race, prolonged definitive surgery time interval and clinical outcomes (i.e., age, socioeconomic status, insurance, and comorbidities such as body mass index). Our goal is to address whether a delay in receiving definitive surgery following diagnosis significantly impacts overall or cancer-specific survival, as narrowing this time window may be a targetable measure for breast cancer care providers in reducing existing racial disparities in cancer care outcomes.