Table 2.

Recent studies evaluating disparities in time to treatment for breast cancer

Study	Design	Setting and number of subjects	Main findings
Babatunde (2021)	Retrospective cohort	South Carolina Central Cancer Registry (SCCCR) and Office of Revenue and Fiscal Affairs (RFA), 2002–2010, n = 2155	• Black women received surgery, chemotherapy, and radiotherapy later than White counterparts • Unadjusted mean time to surgery from diagnosis was longer for Blacks
Benefield (2021)	Population-based study with in-home interview	Carolina Breast Cancer Study Phase III, 2008–2013, n = 437	• After adjusting for stage, Black women with hormone receptor-positive/HER2- high-grade tumors were more likely to experience a treatment delay
Bleicher (2017)	Retrospective cohort	National Cancer Database, 2004–2015, n = 622,793	• After adjusting for all other variables, factors that nearly or more than doubled odds of having > 90 days between diagnosis and surgery included Black race and Hispanic ethnicity
Bustami (2014)	Retrospective cohort study	NYU and Morristown Medical Center tumor registry, 2007–2011, n = 3071	• Longest median time to surgery observed for African American patients and longer absolute difference between African American compared to Whites with difference less pronounced for Asian/other compared to White
Champion (2020)	Retrospective cohort	National Cancer Database, 2004–2015, n = 903,008	• After adjustment, Hispanic White women had longer time to surgery compared to non-Hispanic White women, regardless of treatment sequence • No significant racial differences in time to surgery among Hispanic patients
Doe (2020)	Retrospective cohort	Henry Ford Health System, 2015–2017, n = 541	• Mean time to treatment was significantly longer for Blacks than Whites both before and after implementation of multidisciplinary approach (MDC) • Before MDC, significantly more White patients were treated ≤ 60 days than Black and significantly more Black patients were treated > 60 days but this difference no longer appeared after MDC
Eaglehouse (2019)	Retrospective cohort	Department of Defense Central Cancer Registry and Military Health System Data Repository, 1998–2008, n = 4887	• In multivariable models, NHB women had longer time to surgery than NHW women • Regarding survival, addition of time to surgery to multivariable model did not substantially attenuate the HR estimates compared with adjusted model—NHB had higher risk for all-cause death compared to NHW women
Foy (2018)	Retrospective cohort	James Cancer Hospital, 2005–2014, n = 4593	• Mean number of days between diagnosis and treatment was significantly greater for Black women • Proportion of Black women with more than 90 days between diagnosis and treatment onset was significantly greater than White women
George (2015)	Retrospective cohort	NJ State Cancer Registry, 2005–2010, n = 575	• Median time to surgery was 29 days for White vs. 32 days for Black with 92% of White compared to 80% of Black patients receiving surgery within 2 months of diagnosis • Black patients more likely to experience surgical delay more than 3 months • In models adjusted for situational barriers, Black patients at increased risk for both diagnostic and surgical delay compared to Whites
Halpern (2016)	Retrospective cohort study	Medicaid data, 2006–2008, n = 7452	• Black Medicaid beneficiaries were more likely to experience delays for breast-conserving surgery and outpatient and inpatient mastectomy
Hoppe (2019)	Retrospective cohort	National Cancer Database, 2004–2014, n = 546,351	• Black women had significantly longer times to first treatment, time to surgery, chemotherapy, radiation, and endocrine therapy than White women • Despite private insurance, Black women still had longer time to surgery than White patients
Jackson (2021)	Retrospective cohort	National Cancer Database, 2010–2016, n = 378,499	• Median time from diagnosis to first surgery was longer for Black women than White • 30.6% of Black women had surgery > 60 days from biopsy compared to 18.0% White • On multivariable logistic regression, Black race associated with increased odds of surgery > 60 days from diagnosis
Khanna (2017)	Retrospective cohort	Boston Medical Center, 2004–2014, n = 1130	• Black women had longer time to treatment compared to all other race groups and significance primarily driven by comparison of Black vs. White • On multivariate model with race/ethnicity, marital status, stage, and first treatment delivered, race/ethnicity was the only independent predictor of time to treatment
Khorana (2019)	Retrospective cohort	National Cancer Database, 2004–2013, n = 1,368,024	• On multivariable analysis, race was one of the several predictors of delay • Black race was associated with increased time to initiation compared to White • Increased time to initiation was associated with worsened survival in stage I and II breast cancer
Lamb (2018)	Retrospective cohort	Methodist University Hospital, 2002–2012, n = 3072	• Black women with stage 0, I, II, and III breast cancer all had significantly longer median time to surgery than White women
Polverini (2016)	Retrospective cohort	National Cancer Database, 2004–2012, n = 420,792	• As time to surgery increased, the percentage of Medicaid and uninsured patients and patients of Black or Hispanic race increased • Overall, only time to surgery > 12 weeks was associated with significantly shorter survival • When stratified by stage, stage I patients treated at 8 to < 12 weeks and > 12 weeks as well as stage II patients treated > 12 weeks had decreased overall survival compared with patients treated within 4 weeks
Reeder-Hayes (2019)	Retrospective cohort	Carolina Breast Cancer Study, unknown timeline, n = 2659	• Women with delayed treatment initiation were significantly more likely to be Black • Black women more frequently experience delayed treatment • Even in fully adjusted models, Black women had almost twice the frequency of delayed initiation compared to White women • After adjustment for age, receptor status, grade, and tumor size, a nonsignificant trend association with recurrence risk was suggested for patients with delayed initiation