Comparison against “treatment initiation interval” quality standards in women screened by the Illinois Breast and Cervical Cancer Program (IBCCP) with invasive breast cancer

Purpose: Underserved women are less likely to benefit from early breast cancer detection and treatment. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP), established by Congress to reach underserved women, developed quality standards to benchmark whether diagnostic services and initiation of cancer treatment are timely. NBCCEDP treatment initiation for cancer is benchmarked at ≤60 days of diagnosis; 93% of NBCCEDP-screened women with breast cancer met guidelines in 1996-2005 (Richardson, AJPH 2010). The Illinois Breast and Cervical Cancer Program (IBCCP) provides screening to eligible underserved women. Here, we compare IBCCP-screened women with invasive breast cancer against NBCCEDP benchmarks, and explore racial and other characteristics to identify factors predicting failed benchmarks. Methods: IBCCP data from 1996-2010 were analyzed. Treatment initiation interval was calculated from the date of diagnosis and treatment initiation among women who started treatment. Results: 48,368 breast cancer screening encounters identified 257 invasive cancer cases. Among these, diagnosis and treatment initiation dates were identical in 39 (15.2%), suggesting data error. Among 220 remaining cases, 176 (80.7%) met and 42 (19.3%) failed benchmarks. Univariate analysis failed to identify any statistically significant variables associated with failing benchmarks, including race (p=0.63), marital (p=0.72) or employment status (p=0.72), cancer stage (p=0.55), tumor size (p=0.15), treatment provided (p=0.84), or place of service (p=0.59). Conclusions: A lower proportion of IBCCP women met NBCCEDP treatment initiation intervals benchmarks. Too few women failed standards over the 15-yr time period to identify significant predictors of failure, suggesting larger datasets are needed to identify subtle factors when assessing treatment interval benchmarks.