Breast
Monica G. Valero, MD
Assistant Professor of Surgery (Oncology Breast)
Yale School of Medicine Department of Surgery
Westport, Connecticut, United States
Monica G. Valero, MD
Assistant Professor of Surgery (Oncology Breast)
Yale School of Medicine Department of Surgery
Westport, Connecticut, United States
Monica G. Valero, MD
Assistant Professor of Surgery (Oncology Breast)
Yale School of Medicine Department of Surgery
Westport, Connecticut, United States
Madhav KC, PhD, MPH
Biostatistician
Yale School of Medicine, United States
Rudy El Asmar, MD PhD
Research Fellow
University of Pittsburgh Medical Center, United States
Alyssa Gillego, MD
Assistant Professor of Surgery (Oncology, Breast)
Yale School of Medicine, United States
Ted James, MD,MHCM, FACS
Associate Professor of Surgery
Harvard Medical School, United States
Melanie Lynch, MD
Assistant Professor of Surgery (Oncology, Breast)
Yale School of Medicine, United States
Ellie M. Proussaloglou, MD
Assistant Professor of Surgery (Breast Surgical Oncology)
Yale University
New London, Connecticut, United States
Gregory Zanieski, MD
Assistant Professor of Surgery (Oncology)
Yale School of Medicine, Connecticut, United States
Elizabeth Berger, MD, MS, FACS
Assistant Professor of Surgery (Oncology, Breast)
Yale School of Medicine, United States
Tristen S. Park, MD
Assistant Professor
Yale School of Medicine
New Haven, Connecticut, United States
Barbara Ward, MD, FACS
Chief of Surgery, Surgery; Medical Director, The Breast Center at Greenwich Hospital
Yale School of Medicine, United States
Mehra Golshan, MD, MBA, FACS
Professor of Surgery (Oncology, Breast); Executive Vice Chair, Surgery; Deputy Chief Medical Officer
Yale School of Medicine Department of Surgery
New Haven, Connecticut, United States
Rachel Greenup, MD, MPH
Associate Professor of Surgery (Oncology, Breast); Section Chief of Breast Surgery, Surgery
Yale School of Medicine
New Haven, Connecticut, United States
Disparities in receipt of health services has led to an inequitable treatment of Hispanic women compared to non-Hispanic white patients, including higher rates of uninsurance resulting in poor access to care. We sought to characterize patient-level sociodemographic factors contributing to patterns of breast cancer care among Hispanic women in the United States.
Women diagnosed with stage I-III invasive breast cancer (IBC) between 2010-2020 were identified in the National Cancer Database (NCDB). Those who received neoadjuvant systemic therapy were excluded. The association between insurance status, stage at diagnosis and days to treatment were determined. Treatment delay was defined as >30 days from diagnosis to surgery and >90 days from diagnosis to receipt of chemotherapy. Receipt of guideline-concordant care was evaluated based established breast cancer CoC quality measures.
Overall, N=931,417 women with IBC were identified. Defined by the NCDB, 707,062 (76%) were non-Hispanic white (NHW) 103,870 (11%) were non-Hispanic Black (NHB) 41,856 (4.5%) were Asian 61,361 (7%) were Hispanic 3,046 (0.3%) were Native and 14 (1.5%) were other race. During the study period, there was a ~2% decrease in uninsurance; over half (55%) of Hispanic women were privately insured, 37% had government insurance, and 8% were uninsured. Uninsured Hispanic women were more likely to be diagnosed with stage III disease (OR 1.20 95% CI: 1.16-1.43) when compared to NHW. When compared to NHW women, Hispanic women had greater delay for first surgery (OR 1.35 95% CI 1.32-1.37) and receipt of chemotherapy (OR 1.57 95% CI 1.52-1.61). Notably, insurance status was independently associated with time-to-treatment, with greater delays seen among the uninsured. Hispanic women were less likely than NHW to receive CoC guideline-concordant breast cancer care (OR 1.64 95% CI 1.61-1.68).
Hispanic women with breast cancer experience advanced stage at diagnosis, treatment delays and lower receipt of guideline concordant care, with insurance mitigating these disparities. Patient-facing and policy level interventions aimed at improving tailored care coordination are needed.