Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: The six cities study

Delays between an abnormal screening mammogram and definitive diagnosis of breast cancer may critically impact tumor size, stage at diagnosis, treatment, prognosis, and survival. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as contributing factors. Clinical records of 186 Latinas and 74 NHWs with abnormal screening mammograms were reviewed to determine time to definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis (MTTD) by ethnicity, adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed Latinas taking 2.2 times longer to reach 50% definitively diagnosed with breast cancer vs. NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' MTTD was 60 days vs. 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR]=1.59, 95% CI=1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR=2.11, 95% CI=1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically- and culturally-appropriate interventions to facilitate Latinas' successful entry into, and progression through, the cancer care system.