Later Breast Cancer Treatments May Be Affected By Site of Initial Diagnosis

In a new study published in the Journal of the American College of Radiology, epidemiologist and University of Illinois Cancer Center member Garth Rauscher and his colleagues found that where patients are initially diagnosed with breast cancer has implications for their subsequent diagnosis and treatment experiences.

Rauscher, PhD, and his team found that Black and Hispanic patients are more likely to “present” at a health care facility with fewer resources – known as disproportionate share hospitals ­– that provide a large amount of undercompensated care. These facilities serve predominantly low-income patients and receive payments from the Centers for Medicare and Medicaid Services (CMS) to help cover costs of providing care to the uninsured.

Using data from the Breast Cancer Care in Chicago study, the authors found that 47% of Hispanic and 37% of non-Hispanic Black patients presented initially at a disproportionate share hospital, compared to 11% of non-Hispanic white patients.  Black and Hispanic patients were also less likely to present at highly accredited facilities, such as at Breast Imaging Centers of Excellence. Accredited facilities must meet strict national standards for equipment, operating room safety, personnel and clinician credentials. The authors found that 49% of Hispanic and 46% of non-Hispanic Black patients presented initially at a Breast Imaging Center of Excellence, compared to 81% of non-Hispanic white patients.

Ethnic and minority groups were also found to have less timely treatment, fewer sentinel node biopsies, and fewer hormonal therapy recommendations than white patients. Patients initially presenting at higher resourced and more highly accredited facilities were generally more likely to receive the standard of care for some, but not all, diagnostic and treatment outcomes assessed.

“Health care facilities that have more resources and accreditations often see a more advantaged population. We wanted to understand whether inequities in the resources and accreditation of the initial presentation facility might account for disparities in the quality of diagnostic workup and treatment recommendations,” Rauscher said.

The findings “are the first that we are aware of to examine whether access to accredited versus nonaccredited facilities at initial presentation might influence later medical events during diagnosis and treatment,” he said. “It is not clear to what extent these differences in diagnostic and treatment events are due to differences in quality of care or differences in the characteristics of patients presenting at these facilities.”

Rauscher has conducted research in breast cancer screening, diagnosis and treatment since 2000. He currently serves as co-investigator on grants funded by the National Cancer Institute (NCI) and National Institutes of Health (NIH). He also works with the Metropolitan Chicago Breast Cancer Task Force (known now as Equal Hope) on quality improvement initiatives and research on the value of breast cancer care, and leads the Metro Chicago Breast Cancer Registry (MCBCR), one of six active registries that contribute demographic, radiology, and population-based breast cancer data to the Breast Cancer Surveillance Consortium.

Co-authors on the paper include Cancer Center member Yamile Molina, PhD, Abigail Silva, PhD, and Anne Marie Murphy.

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