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JAMA Oncology study links delays in health care to structural racism

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A recently released study from the Journal of the American Medical Association (JAMA), Oncology led by UW’s Dr. Marissa Lawson, radiology instructor at the University of Washington School of Medicine, found a strong correlation between delays in prompt health care coverage and systemic racism.

After skin cancers, breast cancer is the most common cancer and second most common fatal cancer among women in the United States. In the United States, women of color, particularly Black women, are more likely to experience significant delays in getting breast biopsies after mammograms than white women. 

Mammograms are essential in detecting breast cancer, and biopsy delays reduce the opportunity for early detection. This puts patients at a higher risk of treatment failure, lowering their chances of survival. Minority women are at a concerningly increased risk of receiving a late diagnosis of breast cancer at a later and more deadly stage, according to the study. 

The study reviewed 46,185 cases of women whose screening mammograms had displayed abnormalities that called for a biopsy. In the study population, 34.6% of women were not biopsied within 30 days,16% were not biopsied at 60 days, and 12% were not biopsied within 90 days.

“Structural racism, within and beyond health care, may contribute to these differences,” Dr. Lawson said. 

Black and Asian women are more likely to experience severe delays in receiving breast biopsies after a mammogram identifies an abnormality. The study found delays are influenced by screening site-specific factors that may stem from structural racism. 

The study compared the time to biopsy of white patients as the benchmark. The study found that 30 days out, Asian women had a 66% higher risk of not undergoing a biopsy, while Black women had a 52% higher chance, and Hispanic women were 50% more likely. At 90 days out, Black women had a 28% higher risk of not undergoing a biopsy. For Asian women and Hispanic women, the risk of delayed biopsy was 21% higher and 12% higher, respectively.

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Results suggest that adjustment for multilevel factors did not entirely account for differences in time to breast biopsy. Researchers examined if specific factors of individual patients, neighborhoods, and screening facilities influence the lack of timeliness to biopsy. Unmeasured factors, specifically linked to systemic racism, led to late diagnosis.

Systemic racism continues to be an active player against women of color. The study highlights the disparities women of color face when seeking active treatment and health care — proving that they are underserved. With this study, Lawson calls attention to the need of these women pushing for radiology departments to improve wait times for biopsies. 

When discussing the next steps for health care in protecting minority and ethnic women, Dr. Christoph Lee, a UW professor of radiology and the senior author, suggests new solutions for onsite screening. 

“Our findings highlight an opportunity for radiology departments to consider where they can commit resources to improve wait times for biopsy,” said Dr. Lee. “This could include implementing changes in that diagnostic pathway, such as using navigators to help guide patients through the process of scheduling procedures.” 

Reach writer Renee Diaz at Twitter: @itsreneediaz

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