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Showing content from https://pubmed.ncbi.nlm.nih.gov/33826758/ below:

Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women

Review

. 2021 Jul 15;127(14):2515-2524. doi: 10.1002/cncr.33473. Epub 2021 Apr 7. Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women Yi Ren¹, Cushanta C Horton², Sachiko M Oshima¹, Samantha M Thomas¹, Sherry Wright², Awanya Caesar³, Jennifer K Plichta¹, E Shelley Hwang¹, Rachel A Greenup¹, Laura H Rosenberger¹, Gayle D DiLalla¹, Carolyn S Menendez¹, Lisa Tolnitch¹, Terry Hyslop¹, Debi Nelson², Oluwadamilola M Fayanju¹

Affiliations

¹ Duke University School of Medicine, Durham, North Carolina.
² North Carolina Department of Health and Human Services, Raleigh, North Carolina.
³ Lincoln Community Health Center, Durham, North Carolina.

PMID: 33826758
PMCID: PMC8320193
DOI: 10.1002/cncr.33473

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Review

Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women

Sarah D Tait et al. Cancer. 2021.

. 2021 Jul 15;127(14):2515-2524. doi: 10.1002/cncr.33473. Epub 2021 Apr 7. Authors Sarah D Tait¹, Yi Ren¹, Cushanta C Horton², Sachiko M Oshima¹, Samantha M Thomas¹, Sherry Wright², Awanya Caesar³, Jennifer K Plichta¹, E Shelley Hwang¹, Rachel A Greenup¹, Laura H Rosenberger¹, Gayle D DiLalla¹, Carolyn S Menendez¹, Lisa Tolnitch¹, Terry Hyslop¹, Debi Nelson², Oluwadamilola M Fayanju¹ Affiliations

¹ Duke University School of Medicine, Durham, North Carolina.
² North Carolina Department of Health and Human Services, Raleigh, North Carolina.
³ Lincoln Community Health Center, Durham, North Carolina.

PMID: 33826758
PMCID: PMC8320193
DOI: 10.1002/cncr.33473

Item in Clipboard

Abstract

Background: The North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides breast cancer screening services to underserved women to mitigate disparities in access to care. The authors sought to characterize this understudied population.

Methods: Women 21 years old or older who underwent their first breast cancer screen through NC BCCCP from 2008 to 2018 were included. Demographic factors associated with the timeline of care and odds of a breast cancer diagnosis were identified with negative binomial and logistic regression, respectively.

Results: Of the 88,893 women identified, 45.5% were non-Hispanic (NH) White, 30.9% were NH Black, 19.6% were Hispanic, 1.7% were American Indian, and 1.1% were Asian. Breast cancer was diagnosed in 2.5% of the women (n = 2255). Hispanic women were the least likely to be diagnosed with breast cancer (odds ratio vs NH White women, 0.40; 95% confidence interval [CI], 0.34-0.47). Among patients with breast pathology, the median time to diagnosis was 19 days (interquartile range [IQR], 10-33 days), and the time to treatment was 33 days (IQR, 19-54 days). After adjustments, a longer time to diagnosis was significantly associated with age (incidence rate ratio [IRR], 1.01; 95% CI, 1.01-1.02) and being NH Black (vs NH White; IRR, 1.17; 95% CI, 1.06-1.29). A longer time to treatment was significantly associated with age (IRR, 1.01; 95% CI, 1.01-1.01), being NH Black (vs NH White; IRR, 1.20; 95% CI, 1.10-1.31), and being Hispanic (vs NH White; IRR, 1.22; 95% CI, 1.05-1.41).

Conclusions: NC BCCCP participants with breast cancer received treatment within approximately 1 month of presentation, and this finding aligns with quality care benchmarks. Nevertheless, racial/ethnic disparities in timeliness of care persist, and this suggests opportunities for improvement.

Lay summary: This review of approximately 90,000 participants in a breast cancer screening program for uninsured and underinsured women highlights the importance of safety net programs in providing timely care to underserved patients. The authors found that the North Carolina Breast and Cervical Cancer Control Program met timeliness benchmarks from the Centers for Disease Control and Prevention across all racial/ethnic groups. However, non-Hispanic Black women experienced relative delays in the time to diagnosis, and both non-Hispanic Black women and Hispanic women experienced relative delays in the time to treatment. These findings demonstrate how racial/ethnic disparities in the timeliness of care can persist even within a program intended to reduce barriers to access.

Keywords: breast neoplasms; cancer screening; health care disparities; insurance.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

Cushanta C. Horton, Sherry Wright, and Debi Nelson are employed by the North Carolina Department of Health and Human Services. The findings and conclusions presented are those of the researchers and do not represent the views of the North Carolina Department of Health and Human Services, Division of Public Health. Terry Hyslop and Samantha M. Thomas report personal fees from AbbVie outside the submitted work. The other authors made no disclosures.

Figures
Figure 1.

Program participation over time by…

Figure 1.

Program participation over time by race/ethnicity, North Carolina Breast and Cervical Cancer Control…

Figure 1.

Program participation over time by race/ethnicity, North Carolina Breast and Cervical Cancer Control Program, 2008–2018. PI indicates Pacific Islander.

Figure 2.

Median timeline of care from…

Figure 2.

Median timeline of care from enrollment, North Carolina Breast and Cervical Cancer Control…

Figure 2.

Median timeline of care from enrollment, North Carolina Breast and Cervical Cancer Control Program, 2008–2018.