Abstract PR-10: Impact of race, ethnicity and health insurance on delays in breast cancer diagnosis in the District of Columbia
Authors: Hoffman Heather J. , Levine Paul H. , Young Heather A. , Alexander Lisa M. , Laverda Nancy L. , Patierno Steven R. 
Published: December 2010

Abstract
Background: Delays in follow-up after breast cancer screening are thought to contribute to disparities in breast cancer outcomes. The primary objective of this study is to determine the impact of race/ethnicity and type of health insurance on the diagnostic delay time, defined as the number of days from abnormal screening to definitive diagnosis.
Methods: This is a retrospective study of 976 women examined for breast cancer between 1998 and 2009 at six hospitals and clinics located in the District of Columbia. We used a full-factorial ANOVA model to test for significant differences in diagnostic delay time among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic women with private, government, or no health insurance. A log transformation was taken on the diagnostic delay time to normalize our data, and geometric means were estimated and compared.
Results: The average geometric mean (95% CI) diagnostic delay times were as follows: among those with private insurance, 15.9 (12.2,20.6) days for NHW, 27.0 (22.4,32.6) days for NHB, and 51.4 (34.8,76.0) days for Hispanic women; among those with government insurance, 11.9 (7.3,19.3) days for NHW, 39.5 (32.2,48.6) days for NHB, and 71.6 (47.8,107.1) days for Hispanic women; and among those without insurance, 44.5 (16.4,120.6) days for NHW, 59.7 (38.8,91.8) days for NHB, and 66.4 (55.8,79.1) days for Hispanic women. In fitting a full-factorial ANOVA model, we found that NHW women with government insurance had a significantly shorter delay in diagnosis than NHB (p=0.0003) and Hispanic (p&lt;0.0001) women with government insurance. We also found that NHW women with private insurance had a significantly shorter delay in diagnosis than NHB (p=0.03) and Hispanic (p&lt;0.0001) women with private insurance. However, there were no significant differences within the uninsured women (p&gt;0.05). Finally, we found that NHB women with private insurance had a significantly shorter delay in diagnosis than uninsured NHB women (p=0.03).
Conclusions: NHB and Hispanic women with government or private insurance waited more than twice as long to reach their definitive diagnosis than NHW women with government or private insurance. Uninsured NHB women waited more than twice as long to reach their definitive diagnosis than NHB women with private insurance. Having private health insurance markedly increased the speed of diagnostic resolution in NHB women; however, the speed of diagnostic resolution remained significantly longer for NHB women with private insurance than for NHW women with private insurance. These results suggest that while both insurance and race/ethnicity affect diagnostic resolution, health insurance may not be the primary barrier to optimal diagnostic resolution in NHB women. It will be important to determine what other factors serve as the primary barriers, as well as if these delays affect the final breast cancer outcome for the patients.
Funding Mechanism: Grant Number 1 U01 CA116937; Patient Navigation Research Program (PNRP), Center for Research on Cancer Health Disparities (CRCHD), National Cancer Institute (NCI).
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):PR-10.