Abstract A63: Time course from screening mammography to biopsy to treatment among black and white, non-HMO Medicare beneficiaries in 2005-2008

Background: While breast cancer incidence is higher among whites, breast cancer mortality is higher among blacks. Delays in diagnosis and treatment could contribute. Objective: Describe the time course of screening, diagnosis and treatment among non-Hispanic black and white non-HMO Medicare beneficiaries ages > 65 years. Data and Methods: We selected a 2005-2008 sub-sample of Medicare beneficiaries, restricted to non-Hispanic black women and white women ages 65 years and older who were: alive from at least 2005 to 2007; had out-patient (Part B) Medicare insurance; and were not enrolled in HMO9s for any part of the observation period. For each continental US county or county equivalent we selected a random sample of 250 beneficiaries from each racial/ethnic group, based on analyses showing that n=250 would yield sufficient power to detect differences by race. When counties had 21 days from screening to biopsy and >60 days from biopsy to surgery, radiation, or chemotherapy) and age in 2005, race, depression, Charlson co-morbidity scores and US Census region of residence. Results: Among women receiving biopsies, 7703 or 66.7% had 21 or more days between their most recent mammogram and biopsy. After accounting for co-variables, the delay was 20% (OR 1.20, 95% CI 1.09-1.32) more likely among black beneficiaries than whites and 15% (OR 1.15, 95% CI 1.06-1.25) more likely among beneficiaries with at least one co-morbid condition relative to those with none. The number of days waiting for biopsy were inversely associated with yearly increases in age (OR 0.97, 95% CI 0.97-0.98) and diagnosed depression (OR 0.87, 95% CI 0.77-0.97). Overall, 5236 of the women receiving biopsies were diagnosed with breast cancer (weighted population n=84,837). Among these women, 359 (6.9%) did not start treatment within sixty days and an additional 228 (4.4%) did not start treatment within 60 days or before the end study period. Black women were 2.16 times more likely (95% CI 1.72-2.71) to experience > 60 days post-diagnosis before treatment initiation than white women. Also, yearly increases in age were associated with a 3% (OR 1.03, 95% CI 1.01-1.04, p Conclusions: These descriptive data are consistent with the hypotheses that black race, age, and geographic region of residence are independent predictors of longer waits for biopsy and treatment among non-HMO black and white Medicare elderly. Relationship of depression to delays between screening and biopsy warrants further study. Analytic epidemiologic study is needed to test these hypotheses and determine whether they contribute to disparities in breast cancer mortality. Citation Format: Rebecca Selove, Barbara Kilbourne, Maureen Sanderson, Maya Foster, Mary Kay Fadden, Regina Offodile, Baqar Husaini. Time course from screening mammography to biopsy to treatment among black and white, non-HMO Medicare beneficiaries in 2005-2008. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A63.