The disparity files: Black women more likely to delay breast cancer treatment

Black women with breast cancer took longer to start chemotherapy than white women, and were more likely to delay treatment for ≥90 days than white women, according to a study published online in the May issue of Breast Cancer Research and Treatment. The authors cited communication between the patient and physician as a factor.

Research has established race disparities in breast cancer outcomes. “Black women have higher rates of breast cancer mortality than white women despite lower age-adjusted incidence and comparable mammography use,” wrote Vanessa B. Sheppard, PhD, from the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C., and colleagues.

Sheppard et al hypothesized that black women have lower chemotherapy initiation and greater delay than white women, which could be mitigated by good communication with oncologists. The researchers devised a study of black and white women with breast cancer to assess whether factors related to chemotherapy initiation, days to initiation and treatment delay differ by race.

The study focused on 359 women, 58 percent black and 42 percent white, ages 25 to 89 years, diagnosed with invasive non-metastatic breast cancer.

Patients completed a survey comprised of items to assess communication and level of trust with oncologists.

Sheppard and colleagues reported overall chemotherapy initiation at 39 percent: 30 percent among white women and 46 percent among black women. They observed racial differences in the direction and significance of variables. “The largest difference in effect was for communication, where greater patient-provider communication (vs. less) was associated with higher odds of initiation among blacks, while greater communication was associated with lower initiation in whites.”

Time to initiation ranged from 19 to 180 days, with the mean number of days to initiation at 71.8 days for black women and 55 days for white women. Single status and lower trust in oncologists were positively associated with longer time to initiation.

A total of 21 percent of women, 27 percent of black women and 8.3 percent of white women, who underwent chemotherapy delayed initiation 90 days more.  

“Black and white patients may have different needs and/or preferences for patient-physician communication,” wrote Sheppard et al.

The “art of care,” including race-based communication differences, is complex, they continued, citing the link between greater chemotherapy communication and lower initiation in white women as evidence. One possible explanation may have been differences in information content provided to white women and black women.

Although chemotherapy initiation was higher among women with the strongest clinical indication, Sheppard and colleagues categorized chemotherapy use as suboptimal based on guidelines.

Sheppard and colleagues suggested the need for additional research that incorporates direct observations of encounters and mixed methods, which could help examine patient preferences, interaction with providers and information needs across race. “Until then, the robustness of our results suggests that the patient-physician dyad represents a good leverage point for interventions to improve chemotherapy patterns in black women and ultimately, to reduce race disparities in breast cancer mortality.”

For more about disparities in screening mammography, please read “Mammo’s Missing: Underserved & Overlooked,” in the May/June issue of Health Imaging.