Racial disparities and predictors of receipt of late surgery among patients diagnosed with breast cancer in South Carolina

Background: Diagnosis-to-surgery wait times among breast cancer (BrCa) patients in the United States have increased over the past two decades and have been associated with poorer survival outcomes. Racial disparities have been reported in these diagnosis-to-surgery wait times, with significant odds of delayed treatment found among Blacks. The objective of this study was to identify predictors of late surgery and to assess interactions with race in predicting late surgery among patients diagnosed with BrCa in South Carolina (SC). Methods: We derived data on all female BrCa cases in 2002-2009 from the SC Central Cancer Registry linked with administrative medical and pharmacy claims data from the Public Employee Benefits Plan (private insurance) and Medicaid. The main outcome variable was diagnosis-to-surgery wait time. The exposures explored were patient race (White vs Black), age at diagnosis, marital status, county of residence (rural versus urban), year of diagnosis, estrogen and progesterone hormone receptor status (positive versus negative), tumor stage, tumor grade and enrollment in a government-funded breast and cervical cancer screening program: Best Chance Network (BCN). Chi-square tests and logistic regression analyses were conducted to compare patients who received early ( 30 days after diagnosis) to identify significant predictors of late surgery. Two-way interactions were assessed between covariates hypothesized to modify the effect of race. Results: Of 2137 total BrCa cases, 1633 received early surgery (1213 White, 77.9%; 422 Black, 70.6%). The crude odds of late receipt of surgery were 1.47 (95% CI: 1.19-1.82), and the adjusted odds were 1.32 (95% CI: 1.05-1.66) among Black compared to White patients. The adjusted odds of late receipt of surgery were 2.25 (95% CI: 1.52-3.31) among those who were BCN enrollees versus non-enrollees. Stratified analysis showed that among patients who lived in rural areas, the odds of late surgery were 2.02 (95% CI: 1.34-3.03) among Blacks compared to Whites, whereas among those who lived in urban areas, the odds of late surgery were 1.31 (95% CI: 1.01-1.69) for Blacks compared to Whites. Among patients who were diagnosed between 2002 and 2004, the odds of late surgery were 2.17 (95% CI: 1.40-3.36) among Blacks compared to Whites, whereas among those who were diagnosed between 2005 and 2007, the odds of late surgery were 1.72 (95% CI: 1.17-2.52) for Blacks compared to Whites. Conclusions: Groups that are at higher risk of having late surgery are Blacks who live in rural areas and those on BCN. Despite the trend toward shorter intervals in Blacks vs Whites in the more recent data, all of these disparate groups should be targeted for more intensive navigation efforts. Citation Format: Oluwole Adeyemi Babatunde, Swann Adams, Jan Eberth, Robert Moran, Erica Sercey, Samantha Truman, James Hebert. Racial disparities and predictors of receipt of late surgery among patients diagnosed with breast cancer in South Carolina [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5272.