October 5, 2020

One in seven Black women with breast cancer had delays in starting treatment, and Black women also had extended duration of treatment, according to a study led by researchers from the UNC-Chapel Hill Gillings School of Global Public Health and UNC’s Lineberger Comprehensive Cancer Center.

Dr. Marc Emerson

Dr. Marc Emerson

Dr. Melissa Troester

Dr. Melissa Troester

Melissa Troester, PhD, Marc Emerson, PhD, and their colleagues reported in the journal Cancer that Black women were more likely than white women (13.4% vs. 7.9%) to have the start of their care delayed by at least 60 days after diagnosis. Black women were also more likely to have a longer duration of treatment, as were women under the age of 50 of all races.

The study assessed a variety of patient-reported factors for their impact on delaying start or prolonging duration of treatment. While access to care, tumor status and socioeconomic status did affect treatment start times, these factors had greater impact on the length of care. It was also notable that socioeconomic status was not as strongly connected to treatment delay as race.

“Our study found that Black women experienced delays in both treatment initiation and duration more often than white women. Even among women with low socioeconomic status, we still saw fewer delays among white women, underscoring the disparate experience of Black women, who appear to experience unique barriers,” said Emerson, the paper’s first author, a Gillings alumnus and a postdoctoral fellow at both Lineberger and the Gillings School.

Although they have a similar risk of developing breast cancer, Black women are 42% more likely than white women to die from the disease. Among women younger than 45, the mortality rate for Black women is more than double that of white women.

The researchers analyzed the course of care of 2,841 women enrolled in the Carolina Breast Cancer Study Phase III, which is part of a population-based study that Gillings and Lineberger researchers launched in 1993 to investigate how the causes, treatments and long-term outcomes of breast cancer differ between Black and white women. All the women included in the new analysis were between 24 and 74 years of age at their time of diagnosis and had stage 1, 2 or 3 breast cancer, and approximately half were Black.

The study used latent class analysis to group women according to a wide range of factors related to socioeconomic status, barriers to accessing care, and treatments and other patient factors that contribute to racial disparities.  This aggregation allowed the investigators to consider how some factors may work together to define health care experiences.

“Describing and studying the complex set of factors that influence women’s health care experience is a challenge, but this approach helps develop a more complex understanding,” said Troester, the study’s senior author, a professor of epidemiology at the Gillings School and a professor of pathology and laboratory medicine at UNC’s School of Medicine. “We observed that the duration of treatment was a particularly sensitive indicator of access. This suggests that — in addition to helping patients start treatment on time — we also have to work toward improving access so treatment doesn’t drag on.”

In addition to Troester and Emerson, the paper’s other authors are Yvonne Golightly, PhD, and Allison Aiello, PhD, of the Gillings School; Katherine Reeder-Hayes, MD, and Ugwuji Maduekwe, MD, of UNC Lineberger; Xianming Tan, PhD, and Andrew Olshan, PhD, of both Gillings and Lineberger; and Marian Johnson-Thompson, PhD, of the Susan G. Komen Advocate in Science Steering Committee.

The study was funded in part by grants from the University Cancer Research Fund, Susan G. Komen Graduate Training in Disparities Research, National Cancer Institute and National Institute of Environmental Health Sciences.

Contact the UNC Gillings School of Global Public Health communications team at sphcomms@unc.edu.

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