American Journal of Epidemiology Vol. 142, No. 8: 804-812
Copyright © 1995 by The Johns Hopkins University School of Hygiene and Public Health
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System Delay in Breast Cancer in Whites and Blacks
1Department of Preventive Medicine, Division of Epidemiology, School of Medicine, State University of New York at Stony Brook Stony Brook, NY
2Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University Baltimore, MD
3Department of Health Policy and Management, Division of Health Services Research, School of Hygiene and Public Health, The Johns Hopkins University Baltimore, MD
4Health Surveillance Research Branch, Division of Biometry, National Cancer Institute Bethesda, MD
5Department of Epidemiology, School of Public Health, Emory University Atlanta, GA
6Division of Cancer Prevention and Control, Office of Associate Director, National Cancer Institute Bethesda, MD
Reprint requests to Dr. Lee S. Caplan, Epidemiology and Biostatistics Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.
Survival differences have been noted between black women and white women with breast cancer. It is hypothesized that a prolonged interval between initial medical consultation and establishment of a diagnosis (system delay), resulting in a more advanced stage of disease at diagnosis, might explain part of this survival difference. This study was performed to determine whether system delay differs between black and white breast cancer patients, and to examine predictors of delay in blacks and whites. The study population consisted of 996 female breast cancer patients from the National Cancer Institute's Black/White Cancer Survival Study, a cohort study carried out in 1985–1986 in the metropolitan areas of Atlanta, Georgia, New Orleans, Louisiana, and San Francisco/Oakland, California. The median system delay was slightly longer for blacks than for whites—2.7 weeks versus 2.1 weeks—but this difference was not statistically significant. Having a palpable lump at diagnosis was associated with reduced system delay in both races, while use of a public clinic increased system delay for blacks. Older women were less likely to be subject to longer system delay than younger women, and this effect was somewhat more pronounced in whites. Survival differences between blacks and whites are probably not due to differences in system delay. However, many women had delays of at least 3 months. Given that younger age and the absence of a palpable lump were the factors most predictive of significant system delay, interventions should be targeted specifically toward reducing system delay in younger women who present without the classical painless lump.
breast neoplasms; delivery of health care; diagnosis; ethnic groups; primary health care; racial stocks; survival; time factors.
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