Delay in breast cancer surgery: evaluating patient, healthcare access, and social vulnerability predictors

Clinical guidelines recommend initiating breast cancer treatment within 60 days of diagnosis. We examined the extent to which patient characteristics, healthcare access, and social vulnerability are associated with delay in surgical treatment among breast cancer patients in Arkansas.

We used 2013-2019 data from the linked Arkansas Central Cancer Registry and the Arkansas All-Payer Claims Database (APCD) to identify female patients with breast cancer who received first-line surgical treatment (n = 6,279). Time to surgery (TTS) was defined as the interval between diagnosis and first surgical treatment and dichotomized at 60 days. The American Hospital Association Survey and AHRQ's Social Determinants of Health Database captured hospital- and community-level characteristics of healthcare access. We applied multivariable logistic regression models to assess associations between TTS and predictor variables.

Overall, 12% of patients received surgery after 60 days of diagnosis. Non-Hispanic Black patients had 82% higher odds of surgical delay (adjusted odds ratio [aOR] 1.82; 95% confidence interval [CI] 1.46-2.29) compared to non-Hispanic White patients. Residing in counties with high social vulnerability index scores for housing/transportation (aOR 1.38; 95% CI 1.06-1.81) was associated with greater odds of delay, whereas higher county-level rates of routine doctor visits (aOR 0.89; 95% CI 0.82-0.97) were associated with lower odds of delays.

Disparities in delay in breast cancer surgery persist across race, healthcare access, and community-level vulnerability. These findings underscore the need for strengthened support services and improved continuity of care among vulnerable populations.