Online Program

Assessing Racial Disparities in Breast Cancer Care in New York City

Monday, November 2, 2015

Charles Asumeng, Msc., Primary Care Information Project, NYC Department of Health And Mental Hygiene, Queens, NY
Aurora Amoah, MPH MPP, Primary Care Information Project, New York City Department of Health and Mental Hygiene, Queens, NY
Jason Wang, PhD, Primary Care Information Project, NYC Department of Health and Mental Hygiene, Long Island City, NY
Hector DePaz, MD, Cancer Control Center, Harlem Hospital Center, New York, NY
Shubhada Dhage, MD, Surgery Department, Perlmutter Cancer Center at NYU Langone, New York, NY
Grace Hilyer, EdD, MPH, Columbia University, Columbia University Medical Center, New York, NY
Karen Schmitt, RN, MA, NUR Div of Academics, Avon Breast imaging Center, New York, NY
Caroline Donovan, Msc, Cancer Prevention & Control Program, Department of Health and Mental Hygine, Queens, NY
Mari Carlesimo, JD, Cancer Prevention and Control Program, NYC Department of Health and Mental Hygiene, Queens, NY
Background/objective: To assess the association between race/ethnicity and delays across the care continuum for invasive breast cancer patients.

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 culture
Provision 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

Presenting author's disclosure statement:

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.