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Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis: The Mediating Effects of Health Care Facility Factors

Molina, Yamile PhD*,†; Silva, Abigail PhD; Rauscher, Garth H. PhD*

doi: 10.1097/MLR.0000000000000417
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Background: Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care.

Objectives: We examined racial/ethnic disparities in delayed diagnosis for breast cancer in the Breast Cancer Care in Chicago Study and estimated the potential mediating effects of facility factors.

Research Design and Subjects: Breast cancer patients (N=606) contributed interview and medical record data as part of a population-based study.

Measures: Race/ethnicity was self-reported at interview. Diagnostic delay was defined as an excess of 60 days between medical presentation and a definitive diagnosis. Facility factors included the facility of medical presentation with respect to: (1) accreditation through the National Consortium of Breast Centers; (2) certification as a Breast Imaging Center of Excellence through the American College of Radiology; and (3) status as a disproportionate share hospital through the state of Illinois as well as the number of facilities used between presentation and diagnosis.

Results: Relative to non-Hispanic whites, minorities were more likely to experience a diagnostic delay, present at a nonaccredited facility and at a disproportionate share hospital, and involve multiple facilities in their diagnosis. Together, facility factors accounted for 43% of the disparity in diagnostic delay (P<0.0001).

Conclusions: Initial presentation of breast cancer at higher resourced facilities can reduce diagnostic delays. Disparities in delay are partly due to a disproportionate presentation at lower resourced facilities by minorities.

*School of Public Health, University of Illinois-Chicago, Chicago;

Fred Hutchinson Cancer Research Center, Seattle, WA

Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL

Supported by multiple National Institutes of Health grants (P50CA106743, P50CA148143, R25CA92408). Dr Molina was supported by the University of Illinois-Chicago Center for Research on Women and Gender and the University of Illinois Cancer Center. Dr Silva’s work was supported by the Office of Academic Affiliations (TPP 42-013), Department of Veterans Affairs. The conclusions, opinions, and recommendations expressed in this article are not necessarily that of the Department of Veterans Affairs nor National Institutes of Health.

The authors declare no conflict of interest.

Reprints: Yamile Molina, PhD, 1603 West Taylor, 6th Floor, Chicago, IL 60612. E-mail: ymolin2@uic.edu.

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