Lower Income and Younger Age Linked to Breast Cancer Care Delays in Young Women, Research Finds

Younger women and those on lower incomes face greater risks of delays in breast cancer care, according to a new analysis of data from adolescents and young adults diagnosed with the disease. The findings, published online in CANCER, a peer-reviewed journal of the American Cancer Society, also show that women who experienced delays in diagnosis tended to present with later stages of disease.

Breast cancer diagnosed before the age of 40, which falls before the recommended age for screening, often carries a poor prognosis alongside unique treatment and psychosocial challenges. Younger women tend not to undergo routine screening and may encounter delays in response to breast cancer-related symptoms, partly due to potential biases that they are not old enough to have cancer. Investigators therefore examined the impact of patient and tumour characteristics on delays in care and the effect of those delays on cancer outcomes.

The analysis drew on data from 1,071 individuals enrolled in the Young Women’s Breast Cancer Study, a multi-site prospective cohort of young women diagnosed with breast cancer by the age of 40. The study was conducted at 13 academic and community sites in the US and Canada between 2006 and 2016. The team identified 153 presentation delays, 120 diagnostic delays, and 228 treatment delays.

Presentation delays were defined as 90 days or more from the time of the first patient-reported symptom or symptoms to presentation to a clinician. Diagnostic delays were defined as 90 days or more from the first healthcare visit for symptom or symptoms to the date of biopsy confirming a breast cancer diagnosis. Treatment delays were considered to be 60 days or more between the time of diagnosis and the time of first treatment.

After adjusting for influencing factors, lower annual income was associated with higher odds of presentation delay. Women with annual household incomes below $50,000 were more likely to delay seeking care. This occurred even in a relatively well-insured population, where 85% had commercial or managed care insurance and only 1.2% were uninsured. In contrast, pregnancy at diagnosis, a family history of breast cancer and triple-negative breast cancer were associated with lower odds of presentation delay.

The odds of diagnostic delay were higher for younger patients and lower for those with triple-negative tumours. The youngest women were more likely to experience diagnostic delays after entering the healthcare system. Potential explanations include lower awareness of cancer risk among very young adults, attributing symptoms to other causes and clinicians being less likely to suspect breast cancer in younger patients. Patients with more aggressive tumour types were less likely to have treatment delays.

Those who experienced a delay in breast cancer diagnosis were more likely to have late-stage disease. Presentation delays were also linked with later-stage disease in women with certain HER2-positive tumours, specifically HER2-positive luminal B tumours, underscoring the clinical significance of timely presentation.

Fortunately, delays were not associated with cancer-free or overall survival. However, the authors noted that a later stage at diagnosis may require more extensive surgery, radiation or systemic therapy, which can affect quality of life and other outcomes.

Senior author Kristen D. Brantley, PhD, of the Dana-Farber Cancer Institute, said: “Our study reveals continued issues in care delay among patients with young-onset breast cancer and emphasises a need to improve both patient and provider understanding of young-onset breast cancer risk factors and symptoms to decrease disease burden among these patients.”

Recognising that breast cancer can occur well before the routine screening age remains essential, as does ensuring that suspicious breast changes in very young women receive prompt evaluation. Because socioeconomic status continues to shape access even among insured groups, targeted efforts are needed to reduce barriers.