Early BCa: racial disparities persist despite private insurance

  • Hoppe EJ & al.
  • Breast Cancer Res Treat
  • 3 Nov 2018

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Despite having no delay in presentation, black women with stage 1 breast cancer (BCa) still have longer times to first treatment, surgery, and other therapies than whites in a large US cohort.
  • Having private insurance diminishes some of this effect, but racial disparities persist.

Why this matters

  • Racial disparities in time to care, although not oncologically significant, suggest institutional hurdles beyond private health insurance that must be addressed.

Study design

  • Retrospective cohort of 546,351 patients with stage 1 BCa in the US National Cancer Data Base: 90.6% were white, 9.4% were black.
  • Funding: None disclosed.

Key results

  • Black women (vs white), regardless of insurance type, had significantly (P<.001 longer times to:>
  • first treatment (35.5 vs 28.1 days),
  • surgery (36.6 vs 28.8 days; Δ, 7.8 days),
  • chemotherapy (88.1 vs 75.4 days),
  • radiation (131.3 vs 99.1 days), and
  • endocrine therapy (152.1 vs 126.5 days).
  • In the subgroup with private insurance:
    • Time to surgery for blacks (vs whites) decreased by 1.2 days (from 7.8 to 6.6 days=1.2 days), but still remained significant, as did all other times to treatment (all P<.001>
    • Black women had worse OS (94.3% vs 95.9% in whites; P<.001>

Limitations

  • Retrospective, observational design.

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