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Assessing Racial Disparities in Breast Cancer Care in New York City
Methods: From 2008 to 2011, we conducted a retrospective chart review for women ages 18 and above at three NYC hospitals. Logistic regression models were used to assess the association between race/ethnicity and delays across the continuum of care. The two outcome variables were (1) diagnostic delay, defined as a period of 60 or more days between diagnosis of abnormal mammogram and biopsy, and (2) treatment delay, defined as a period of 90 or more days between biopsy and treatment (surgery, neo-adjuvant therapy).
Results: A total of 849 women with a mean age of 56 years (SD: 13.53) were included in the analysis, of whom 36% (302) were black, 25% (215) white, 24 % (202) Hispanic, and 15% (130) Asian/Pacific Islander. Of the 86% (729) who underwent a biopsy, 74% did not experience any diagnostic delays. In comparison to white women, black (OR 2.92, CI: 1.54-5.56), Hispanic (OR 2.35, CI: 1.20-4.60) and Asian/Pacific Islander (OR 2.24, CI: 1.05-4.76) women were more likely to experience diagnostic delays. The majority (83%) of the 665 women who received treatment did not experience treatment delays, and there was no association between race/ethnicity and treatment delay.
Conclusions: Racial disparities exist during the diagnostic stage but not for treatment. The findings support intervention at the diagnostic stage; and underlines the importance of coordinated care that can help improve survival rates for minority women, especially when there is no disparity associated with treatment.
Learning Areas:
Diversity and cultureProvision of health care to the public
Public health or related research
Learning Objectives:
Describe disparities associated with breast cancer care;
Explain the continuum of care for women with abnormal mammograms;
Demonstrate the result of a disparity study for women presenting for breast cancer treatment at large hospitals in NYC;
Keyword(s): Cancer and Women’s Health, Health Disparities/Inequities
Qualified on the content I am responsible for because: I am the Principal Investigator of this study involving investigators from three large NYC hospitals and a consulting firm. My twenty years of service with NYC DOHMH conducting epidemiological analysis on areas of Tuberculosis Control and other chronic diseases, ensuring confidentiality on chart reviews; performing public health detailing with primary care physicians in underserved communities coupled with surveillance on immunization; especially overseeing the measles outbreak in Brooklyn prepares me to ensure completion of this project.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.