Identifying Structural Racism Through Breast Cancer Treatment Delays

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Black breast cancer patients are about twice as likely than White patients to experience delays in treatment, the results of a new study on structural racism show. The research reveals that 7.95% of White patients and 14.9% of Black patients reported treatment delays. Results were published online Tuesday in the Journal of Clinical Oncology.

A research team led by Katherine E. Reeder-Hayes, M.D., MSCR, MBA, FASCO, a breast cancer researcher at the Lineberger Comprehensive Cancer Center at the University of North Carolina, used the North Carolina Central Cancer Registry to identify 32,095 patients- 25,905 White patients and 6,190 Black patients. These patients were then linked to the Cancer Information and Population Health Resource. County-level healthcare data came from the Robert Wood Johnson County Health Rankings database.

To quality for this study, patients had to have been diagnosed between 2004 and 2017. A delay in treatment was classified as a span of more than 60 days between diagnosis and the date of first claim for surgery or chemotherapy.

Treatment delays were calculated across five groups. They were:

• Housing and physical environment (renting vs. owning)
• Education (percentage of those at least 25 years old with a high school or less education)
• Employment (percentage of unemployment)
• Income (median household income)
• Overall health (amount of preventable hospital stays per 100,000 Medicare enrollees and uninsured gaps)

Odds ratios were higher for Black patients in all categories except for in the Housing/Physical environment group. The higher the odds ratio, the greater the chance for a delay.

“Black patients are less likely to receive timely surgery,chemotherapy, and radiation and take longer to complete similar therapy compared with white patients,” Reeder-Hayes writes in the study. “Treatment delayshave been linked consistently to higher recurrence and mortality risk, suggesting that delays play a role in persistent racial gaps in [breast cancer] mortality.”

In addition, when compared with White patients, Black patients were more often on Medicaid (46.7 v. 14.4%), at a higher cancer stage (40.4 v. 33.7%) and younger (64 v. 68).

“Increasing county level [structural racism] is associated with increasing Black-White disparities in treatment delay” Reeder-Hayes continues. “Further research is needed to refine the measurement of [structural racism] and to examine its association with other cancer care disparities.”

Researchers note that structural racism is not specifically a Black-White issue, but rather exists among all races. Future studies should examine the impacts on all minority groups.