Treatment delays after breast cancer diagnosis shorten survival
April 29, 2013 | by Roberta Nichols
Delaying breast cancer treatment after diagnosis, even for a matter of weeks, can shorten a woman’s life, particularly if she is young, poor, Hispanic or African-American, and lacks private health insurance, according to a new study.
“Five-year survival rates are lowest for adolescent and young adult women, and only a few studies have examined the impact of delay in treatment, race/ethnicity, and other socioeconomic factors on survival in AYA [adolescent and young adult] women,” wrote Hoda Anton-Culver, Ph.D., chair of epidemiology at the University of California, Irvine, and senior author of the study published online April 24 in JAMA Surgery.
Breast cancer in adolescents and young adults (between 15 and 39 years of age) accounts for only about 5 to 6 percent of breast cancer cases in the U.S., but their outcomes are worse because the disease is more aggressive than in older women.
Researchers found that treatment delay time of more than six weeks was significantly different between racial and ethnic groups, with Hispanic and African-America women almost twice as likely as non-Hispanic white women to experience a delay of more than six weeks (15.3 and 8.1 percent, respectively). Similarly, poor women and those with public insurance or no insurance were almost twice as likely to experience treatment delays as higher-income women or those with private insurance.
Ninety percent of women treated less than two weeks after diagnosis were alive five years later. However, of those whose treatment began more than six weeks after diagnosis, only 80 percent reached the five-year survival mark.
“It is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life,” researchers wrote.
In an interview with Healthday, Anton-Culver noted that no matter what women’s economic station, they should remember that cancer is an equal-opportunity disease. Higher-income women who may put off treatment because of carpools or work projects – or denial – also put themselves at risk.
“The cancer is not going to be put on hold until you organize yourself,” she said. “What we’re saying in this paper is that you can’t say, “OK, I have breast cancer but I have to do A, B and C first, then I will pay attention to that.”
In another breast cancer study also published in JAMA Surgery on April 24, researchers from the University of Toledo Medical Center in Ohio analyzed the cases of 1,539 women with stage 1 through stage 3 invasive breast cancer who had surgery between 1996 and 2009.
They found that women covered by Medicaid had larger tumors at diagnosis (3.3 cm versus 2.1 cm) than women with private insurance. They also found that women on Medicaid were more likely to get a mastectomy (60 percent compared to 39 percent) than women with private insurance.
Detecting the disease earlier, including increasing mammogram screenings for women on Medicaid, might lead to more women having the option of breast-conserving surgery.
“Increasing screening programs for underinsured patients might help reduce this disparity in care,” Laura Kruper, M.D., director of the Rita Cooper Finkel and J. William Finkel Women's Health Center and head of breast surgery service at City of Hope, told Healthday. Yet, added Kruper, who was not involved in the study, the research has limitations.
“We don’t know what the delay is between feeling something [such as a lump] and getting a diagnosis.” Women may delay treatment because they are in denial or lack access to care, she pointed out. “Women who are lower socioeconomic status don’t always have someone to watch their kids when they go in for an appointment,” she added.
Ending disparities will take time, said Kruper. Educating women about the need for screening and for prompt treatment is complex, and solutions will need to factor in educational differences and barriers in language and cultural barriers. “There is not one single approach that will work for all patients,” she said.