The time to surgery (TTS) after a breast cancer diagnosis is longer for black women in the U.S. Military Health System (MHS) than white women, according to research published in JAMA Surgery.
“Previous studies have shown that black women with breast cancer had worse overall survival than their white counterparts within the MHS,” wrote Yvonne L. Eaglehouse, PhD, Uniformed Services University and Walter Reed National Military Medical Center in Bethesda, Maryland, and colleagues. “However, to our knowledge, TTS after a breast cancer diagnosis has not been evaluated in the MHS population in relation to race and clinical outcomes.”
The retrospective study explored MHS data from Jan. 1, 1998, to Dec. 31, 2008, covering more than 900 non-Hispanic black (NHB) women and more than 3,800 non-Hispanic white (NHW) women who received a breast cancer diagnosis and went on to undergo breast-conserving surgery or a mastectomy. The mean patient age was 50 years.
Overall, the median TTS for NHB women was 22 days. For NHW women, it was 21 days. NBW women had a “significantly greater estimated TTS at the 75th and 90th percentiles than NHW women," the authors wrote. The surgery type did not impact the differences.
Reviewing their findings, Eaglehouse et al. noted that other factors besides patient access and insurance “may play a role” in this longer TTS for NHB women.
“Patient and tumor factors, such as comorbid conditions or hormone receptor negative status, which tend to be more prevalent among NHB women than NHW women, could also influence surgical treatment decisions and delay treatment,” the authors added. “Nevertheless, we controlled for comorbidities and estrogen receptor (ER) and progesterone receptor (PR) status in our data analysis.”
Genetic risk, patient attitudes and cultural factors were other potential factors listed in the study.
“In the universal access MHS, NHB women had longer TTS than NHW women,” the authors concluded. “However, surgical delays did not appear to explain observed racial disparities in survival. Future research on factors that influence surgical decisions, treatment delays, and short-term and long-term clinical outcomes is warranted to better understand racial disparities in breast cancer treatment and overall survival.