ArticleCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology2025
Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness.
Article in Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- Comparing Neighborhood Indices of Socioeconomic Status, Segregation, and Healthcare Access for Predicting Late-Stage Breast Cancer.Journal of urban health : bulletin of the New York Academy of Medicine · 2026Article
- Public health determinants of screening accessibility, diagnostic and treatment timeliness, care adherence, and survival outcomes in breast cancer patients.Frontiers in public health · 2026Article
- Tumor biology and access to care and metastatic breast cancer outcomes.Breast cancer research and treatment · 2025Article
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11 authors.
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Abstract
backgroundGeographic disparities in breast cancer outcomes exist. Few studies have examined community- and health system-level factors associated with care timeliness, an important measure of care quality.
methodsThe Carolina Breast Cancer Study is a population-based cohort of 2,998 women with invasive breast cancer (2008-2013). Using latent class modeling, patients' census tracts of residence were characterized by healthcare accessibility and affordability. Centers for Medicare and Medicaid Services ratings were used to classify hospitals as low- or high-quality. Six timeliness outcomes were assessed: (i) lacking prediagnostic regular care, (ii) being underscreened, (iii) late-stage diagnosis, (iv) delayed treatment initiation, (v) prolonged treatment duration, and (vi) lacking receipt of Oncotype DX genomic testing. Associations of geographic accessibility, healthcare affordability, and hospital-level quality with care timeliness were evaluated with relative frequency differences (RFD) and 95% confidence intervals (CI).
resultsCompared with "high-accessibility, high-affordability" census tracts, patients residing in "low-accessibility, low-affordability" areas were more likely to be underscreened (RFD = 18.7%, CI, 13.0, 24.3), have late-stage diagnosis (RFD = 6.2%, CI, 2.4, 10.1), and experience prolonged treatment (RFD = 6.9%, CI, 1.4, 12.3). "High-accessibility, low-affordability" areas had the highest frequency of treatment delay (RFD = 9.3%, CI, 3.9, 14.7). Initial surgery at a high-quality facility was associated with less delayed treatment (RFD = -3.9%, CI, -7.5, -0.4) and prolonged treatment (RFD = -5.9%, CI, -9.9, -1.9).
conclusionsCommunity- and health system-level factors were associated with timely breast cancer care. IMPACT: Policy efforts to improve access in communities should consider multiple dimensions of access, including geospatial accessibility and affordability.
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