Racial, ethnic, and neighborhood-level disparities across the breast cancer care continuum: Time from abnormal imaging to biopsy and treatment initiation.

Abstract

214 Background: Timely breast cancer diagnosis and treatment are critical to optimizing outcomes, yet disparities persist across racial, ethnic, and socioeconomic groups. We evaluated socioeconomic disparities in time to biopsy and treatment initiation after abnormal imaging. Methods: We conducted a retrospective cohort study using institutional data from 2017–2025. Time from abnormal breast imaging to biopsy and time from diagnosis to first treatment (surgery, chemotherapy, radiation therapy, immunotherapy, or endocrine therapy) were analyzed using Kaplan-Meier methods. Multivariable Cox proportional hazards models were used to evaluate associations between race/ethnicity, Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and timeliness of care while adjusting for age, year of diagnosis, insurance status, and cancer stage. Results: Among 3,941 patients, of whom 66.8% were White non-Hispanic, 13.6% Black non-Hispanic, 12.7% Hispanic, and 6.9% Other/Unknown, Black and Hispanic patients experienced longer median times to biopsy (14 and 13 vs 11d) and treatment initiation (51.5 and 49 vs 42d) than non-Hispanic White patients and had higher odds of delayed treatment (>60 days) (OR 1.71 and 1.69 respectively; both p<0.001). Patients residing in high-ADI and high-SVI neighborhoods experienced longer times to biopsy (14 vs 10 and 11d) and treatment (40 and 41 vs 36d). In adjusted analyses, Black (HR 0.82) and Hispanic patients (HR 0.86) had significantly longer time to biopsy. High ADI (biopsy HR 0.90; treatment HR 0.85) and high SVI (biopsy HR 0.89; treatment HR 0.82) remained independently associated with delayed biopsy completion and treatment initiation. Conclusions: Disparities in breast cancer care begin before a diagnosis is established and persist through treatment initiation, disproportionately affecting racial and ethnic minority patients and those residing in socioeconomically disadvantaged communities. Targeted interventions addressing socioeconomic barriers are needed to improve equitable access to timely breast cancer care. Race, ethnicity, and neighborhood-level disparities in time to biopsy and treatment initiation. Group Time to Biopsy (Median Days)* Time to Treatment (Median Days)* Adjusted Measures of Delayed Care (HR/OR, 95% CI) Non-Hispanic White 11 42 REF Non-Hispanic Black 14 51.5 Biopsy HR 0.82 (95% CI 0.74–0.92); Treatment delay OR 1.71 (95% CI 1.41–2.07) Hispanic 13 49 Biopsy HR 0.86 (95% CI 0.76–0.96); Treatment delay OR 1.69 (95% CI 1.38–2.06) Low ADI 10 36 REF High ADI 14 40 Biopsy HR 0.90 (95% CI 0.82–0.99); Treatment HR 0.85 (95% CI 0.77–0.93) Low SVI 11 36 REF High SVI 14 41 Biopsy HR 0.89 (95% CI 0.81–0.98); Treatment HR 0.82 (95% CI 0.75–0.90) *Median differences in time from abnormal imaging to biopsy and from diagnosis to treatment initiation were significant (all p<0.001).