Abstract C18: Are facility characteristics where the patient initially presented associated with breast cancer diagnostic and treatment outcomes? Implications for racial/ethnic disparities in breast cancer outcomes
Authors: Hughes Alejandro , Silva Abigail , Murphy Anne-Marie , Rauscher Garth 
Published: March 2017

Abstract
Background: Non-Latina (nL) Black and Latina breast cancer patients are more likely to be diagnosed at later stages and to experience shorter survival, compared to their nL White counterparts. Many studies, both nationally and in Chicago, have documented racial/ethnic disparities in many aspects of screening, diagnosis, and treatment for breast cancer, but few have examined the role of the facility where the problem that was later diagnosed as breast cancer was initially brought to medical attention (presentation facility). Prior research, as part of the Breast Cancer Care in Chicago (BCCC) study, found that breast cancer patients who initially presented at more highly accredited facilities and at higher-resource facilities were less likely to experience a prolonged diagnostic delay, and that meaningful racial/ethnic disparities in delay could be accounted for by differences in presentation facility. While this result highlights the potential influence of presentation facility on a proximal outcome (diagnostic delay), the present analysis aimed to further examine associations with the types of diagnostic work-up and treatment delays.
Methods: In the BCCC (2005-2008), 989 newly diagnosed nL White, nL Black, and Latina patients with a first primary in-situ or invasive breast cancer, aged 30-79 at diagnosis were interviewed. Of these, 848 provided consent for medical record abstraction, and so were included in these analyses. Four characteristics of presentation facilities were examined: disproportionate share hospital (DSH) status (a marker of high Medicaid and uninsured volume), certification as a Breast Imaging Center of Excellence (BICOE), membership in the National Consortium of Breast Centers (NCBC), and the National Accreditation Program for Breast Centers (NAPBC). Outcomes representing potential indicators of quality of care included receipt of surgical versus core biopsy, sentinel node vs. axillary dissection, re-excision versus not, mastectomy versus lumpectomy, and prolonged radiation (&gt;90 days), chemotherapy (&gt;90 days) and overall treatment delay (&gt;60 days). P-values for crude analyses were based on χ2 tests of associations.
Results: NL Black and Latina patients were more likely than Whites to present at a DSH facility (38% and 48% vs 12%; p&lt;0.001) and less likely to present at a BICOE (45% and 49% vs. 79%, p&lt;0.001) or NAPBC facility (22% and 10% vs. 53%, p&lt;0.001). Presentation at a BICOE facility was inversely associated with surgical biopsy (4% vs 11%; p&lt;0.001), and presentation at a NAPBC facility was positively associated with receipt of a sentinel node biopsy (68% vs 55%; p=0.003). Presentation at a DSH facility was associated with surgery delay (23% vs 13%; p=0.002) and radiation delay (69% vs 53%; p=0.005) whereas presentation at a BICOE facility was inversely associated with overall treatment delay (12% vs 20%; p=0.003) and surgery delay (14% vs 21%; p=0.01). Presentation at a NAPBC facility was inversely associated with overall treatment delay (6% vs 19%; p&lt;0.001), surgery delay (9% vs 20%; p=0.001), and radiation delay (37% vs 62%; p&lt;0.001) but positively associated with chemotherapy delay (81% vs 65%; p=0.003).
Conclusion: Presentation facility characteristics were associated with several aspects of diagnosis and treatment quality indicators. Results implicate a role of presentation facility in diagnostic and treatment-related quality. Limitations that will be addressed in subsequent analyses include multivariable adjustment of patient and tumor factors that might influence these associations.
Citation Format: Alejandro Hughes, Abigail Silva, Anne-Marie Murphy, Garth Rauscher. Are facility characteristics where the patient initially presented associated with breast cancer diagnostic and treatment outcomes? Implications for racial/ethnic disparities in breast cancer outcomes. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C18.