Disparities in breast cancer treatment among American indian, Hispanic and non-hispanic white women enrolled in medicare

Because racial/ethnic disparities in breast cancer survival have persisted, we investigated differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White (NHW) women. Surveillance, Epidemiology and End Results data linked to Medicare claims in New Mexico and Arizona (1987-1997) among enrollees aged 65 and older were used to identify treatment, treatment interval, and mortality risk associated with delays in care. We identified 2,031 women (67 American Indian, 333 Hispanic and 1,631 NHW women with time to treatment information. Treatment intervals from diagnosis to surgery (all stages, 18 versus 4 days, p<.001) and surgery to radiation (stages I/II, 69 versus 35 days, p<.01), were significantly greater for American Indian women than for NHW women. This disparity remained statistically significant after adjustment for age, stage, grade, year of diagnosis, poverty, and distance to care. There was no statistically significant difference in treatment among Hispanic women. Further, American Indian women without surgery within 6 months experienced a 5.6-fold higher breast cancer mortality (p<.05). The duration of time to surgery and radiation has not been previously reported for American Indian women. These results suggest older American Indian women experience significant delays in cancer treatment, resulting in greater breast cancer mortality.