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Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study

Amelie G Ramirez17*, Eliseo J Pérez-Stable2, Gregory A Talavera3, Frank J Penedo4, J Emilio Carrillo5, Maria E Fernandez6, Edgar Muñoz1, Dorothy Long Parma1, Alan EC Holden1, Sandra San Miguel de Majors1, Anna Nápoles2, Sheila F Castañeda3 and Kipling J Gallion1

Author Affiliations

1 Institute for Health Promotion Research, Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

2 Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, University of California, San Francisco, CA, USA

3 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA

4 Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA

5 Weill Cornell Medical College, Cornell University, New York, NY, USA

6 Center for Health Promotion and Prevention Research, University of Texas – Houston Health, Science Center School of Public Health, Houston, TX, USA

7 The National Latino Cancer Research Network, Institute for Health Promotion Research, Cancer Therapy & Research Center, The University of Texas Health Science Center at San Antonio, 7411 John Smith Drive, Suite 1000, San Antonio, TX, 78230, USA

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SpringerPlus 2013, 2:84  doi:10.1186/2193-1801-2-84

Published: 5 March 2013

Abstract

Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities.

As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics.

Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas’ median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women’s diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011).

Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas’ successful entry into, and progression through, the cancer care system.

Keywords:
Health disparities; Breast cancer screening; Definitive diagnosis; Latinas; Six cities study