Abstract P5-10-05: Time differences in breast cancer diagnosis among minorities in a large referal academic center
Authors: Acuna A , Gligich O , Khan H , Xue X , Lin J , Sparano J , Anampa J 
Published: May 2019

Background: Breast cancer (BC) is the most common malignancy and leading cause of cancer death in women. BC incidence is lower in Hispanic (H) (91.9/100,000) compared to non-Hispanic Whites (NHW -128.1/100.000) and Non-Hispanic Black (NHB - 124.3/100,000) population; however, mortality rate is higher in NHB (31/100,000) compared to NHW (21.9/100,000) and H (14.5/100,000). Diagnosis delay is a plausible factor that may explain differences in BC clinical outcomes among different race/ethnicity subgroups.

Objective: To compare time to diagnosis (TTD) by race/ethnicity in women with breast cancer diagnosed at Montefiore Medical Center from 2004 to 2012.

Methods: Patients with breast cancer and available race/ethnicity information diagnosed between 2004 and 2012 were categorized into 4 race/ethnicity groups: NHB, NHW, H or Asian. Dates of screening mammogram, diagnostic mammogram and biopsy were obtained. TTD was defined as the time difference between abnormal mammogram and biopsy dates.

Results: 919 patients had ethnicity information, 302 (32.8%) were H. TTD was longer in H compared to non-Hispanics (35 vs 31 days, z=2.2, p=0.02). Race and ethnicity information was available for 834 patients with a mean age of 62 years (SD:12.4). Of these, 252 (30.2%) were H and 387 (46.4%) were NHB. NHW had the shortest TTD (30 days), the highest frequency of Stage I (70%) and lowest frequency of high-nuclear grade (15.6%). NHB had a TTD of 31 days and higher frequency of triple negative disease (18.9%). TTD was significantly longer in H compared to NHW (35 vs 30 days, z=2.3, p=0.02), and there was a non-significant longer TTD when comparing H versus NHB (35 vs 31 days, z=1.9, p=0.0574). TTD between NHB and NHW was not different (31 vs 30 days, z=1.4, p=0.14).

Conclusions: The longer TTD in H vs Non-Hispanics was driven by the TTD in NHW. NHW had shorter TTD and more favorable pathological features which could lead to lower mortality rate. There was no difference in TTD between NHW and NHB but the latter had higher frequencies of triple negative disease. Correlation between TTD and mortality in our population will help to clarify the clinical effect of TTD differences among race/ethnicity subgroups.

 Total (n= 834)Not Hispanic Black (n=387)Not Hispanic White (n=180)Hispanic (n=302)Asian (n=15)Age (SD)62 (12.4)62.965.261.6 (11.9)53.2Stage*     I613 (65.7)239 (61.6)126 (70)202 (67.3)10 (66.7)II242 (25.9)121 (31.3)36 (20)71 (23.7)3 (20)III56 (6)19 (4.9)12 (6.7)20 (6.7)3 (15.3)IV21 (2.3)8 (2.1)6 (3.3)7 (2.3)1 (1)Histology*     IDC697 (75.1)292 (75.5)121 (67.2)224 (74.7)13 (86.7)ILC81 (8.7)34 (8.8)23 (12.8)21 (7)2 (13.3)Mixed140 (15.1)57 (14.7)33 (18.3)49 (16.3)0 (0)Grade*     High253 (28.4)138 (35.7)28 (15.6)73 (24.3)4 (26.7)Moderate426 (48)155 (40.1)86 (47.8)151 (50.3)9 (60)Low210 (23.6)83 (21.5)49 (27.2)62 (20.7)1 (6.7)Receptor status*     ER positive762 (81.8)286 (73.9)162 (90)258 (86)12 (80)PR positive632 (67.8)229 (59.2)137 (76.1)219 (73)11 (73.3)HER-2 positive143 (15.4)70 (18.1)14 (7.8)49 (16.3)5 (33.3)Triple negative115 (12.3)73 (18.9)14 (7.8)21 (7)1 (6.7)Times     Time to diagnosis33 (20-52)31 (19-52)30 (19-44.5)35 (21-58.5)42 (21-72)Screening to Diagnostic22 (14-36)22 (13-36)21 (13-32)23 (14-14)26 (17-37)Diagnostic to Biopsy7 (0-13)7 (0-13)6 (0-14)7 (1-13)5 (0-9)

Citation Format: Acuna A, Gligich O, Khan H, Xue X, Lin J, Sparano J, Anampa J. Time differences in breast cancer diagnosis among minorities in a large referal academic center [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-05.