Why Do BIPOC Women Face Delays For Lifesaving Biopsies?

Inequities in access to medical care still affect people in the Black, Indigenous, and people of color (BIPOC) community.

A study found that women of color are statistically more likely to experience delays in receiving diagnostic biopsies after an abnormal mammogram (x-ray of the breast tissue).¹ Unfortunately, when your race and ethnicity affect your access to cancer care, from screening and detection to diagnosis and treatment, your prognosis and cancer outcome are affected.

Let’s explore the latest research into the delays BIPOC women face in receiving biopsies and the consequences of this in more detail.

Breast cancer cases are on the rise

You probably know someone who has been diagnosed with cancer. Yet, despite cancer’s prevalence, many people struggle to access potentially lifesaving cancer screening tests.

Across the US, Black people have a higher risk of experiencing negative health outcomes from a cancer diagnosis. Consider these statistics:

• Of any ethnic group in the US, Black people have the highest mortality rate and shortest survival rate for many cancers.²

• Despite Black women having an 8% lower incidence rate than White women for all cancers, they still have a 12% higher mortality rate.³ One of the worst disparities is in breast cancer mortality rates.

According to the National Cancer Institute, breast cancer is the most common form of the disease diagnosed across the US. Over 300,000 people were expected to receive a diagnosis in 2023.⁴ Of this group, women in the BIPOC community were expected to be more heavily impacted.

• Breast cancer is the leading cause of cancer death for Black and Hispanic women. It’s the second leading cause of cancer death among women overall after lung cancer.⁵

• Despite having a lower incidence of disease, Black women diagnosed with breast cancer are 40% more likely to pass away from the condition than their White counterparts.⁶

• Black, Hispanic, and American Indian/Alaskan Native (AIAN) women are less likely to be diagnosed with early-stage local breast cancer (57–60%).⁷ The early diagnosis rate for White women in America is 68%.⁸ Early diagnosis, while the cancer is still in the local stage, is crucial for timely treatment and better outcomes.

• Between 2015 and 2019, breast cancer incidence rates increased across different ethnic groups. Research shows an increase of 0.5% in White women, 0.7% in Black women, 1.4% in Hispanic women, 2.0% in AIAN women, and 2.1% in Asian/Pacific Islander (API) women during this period.⁹

• Breast cancer mortality rates have declined across all ethnicities over the past few decades, except the AIAN group. The mortality rate in this group has only stabilized.¹⁰

Mammograms and biopsies are standard preventative care practices

With breast cancer cases on the rise, what can be done to better identify and treat the condition?

The United States Preventative Task Force (USPSTF), an organization made up of specialists and researchers, recommends ways for healthcare professionals to provide preventative care to catch early-stage disease. The USPSTF’s current recommendations for breast cancer screening are:¹¹

• Women aged 50–74 with an average level of risk should receive a routine mammogram every two years.

• Women aged 40–49 with breast cancer risk factors (such as a family history of the condition, genetic mutations, and radiation exposure) should speak to their primary care provider to see if they should start mammogram screening earlier. This could be as early as 25 years old, depending on your doctor’s risk assessment and after weighing the benefits against the risks.¹²

• If your mammogram results indicate you have an abnormality (a lump or bump your doctor wants to examine in closer detail), you will be referred for a diagnostic biopsy. This is the only way to confirm a cancer diagnosis.

The idea of undergoing a biopsy can be a little frightening — especially receiving the results. However, 80% of women who have this procedure do not have breast cancer and receive negative biopsy results.¹³

Unfortunately, some people have undiagnosed breast cancer for months. Despite getting a screening mammogram that showed abnormalities, they end up waiting for a long period to get their biopsy. Every day of delay causes a later diagnosis and treatment. This leads to significantly worse outcomes and survival rates.

BIPOC women are more likely to experience care delays

Unfortunately, inequitable access to medical procedures is a recurring issue across the US, particularly for people in the BIPOC community.

Looking to explore this phenomenon in more detail, researchers carried out a study with a cohort of over 45,000 American women aged 40–79 who had received an irregular mammogram result between 2009 and 2019.¹⁴

Throughout the study, the time between receiving an irregular mammogram result to undergoing a diagnostic biopsy was measured in relation to ethnicity and race. The results highlighted a concerning pattern of care inequity for BIPOC women.

• Over 15,000 women (35.6% of participants) hadn’t had a follow-up biopsy within 30 days of their irregular mammogram, over 7,000 women (16.2%) hadn’t within 60 days, and over 5,000 women (12.2%) hadn’t within 90 days.¹⁵

• On average, White women received a biopsy within 20.7 days. The averages for other ethnic groups were longer: 30.3 days for Asian women, 29.3 days for Black women, and 26.9 days for Hispanic women.¹⁶

• BIPOC women were less likely to receive a biopsy within 60 or 90 days after their abnormal mammogram results.

• Asian women had the lowest likelihood of receiving a biopsy within 60 days.

• Black women were less likely to have their biopsy within a 90-day window than White women who received care from the same facility.¹⁷

• Even when adjusted to account for facility, neighborhood, and individual, the study data still showed significant health disparities and risks for BIPOC women. The most substantial risks impacted Black women, who had the highest risk of not receiving a biopsy within 90 days.

Throughout the study, the impact of societal structures was explored as a possible cause of unfair access to care. The researchers proposed that after adjusting for differences between facilities, structural racism within and outside the healthcare system was a possible factor in delayed care in the BIPOC community.¹⁸

Expanding on this, the researchers suggested that there are sources of racism in healthcare at every level of the system. Here are some examples:

• How screening clinics communicate information to patients

• Access to easy-to-use scheduling programs

• Availability of language translators

• Insurance coverage and reimbursement

• How hospitals allocate medical resources

This was the largest clinical study about racial differences and access to cancer biopsies. The data (from established registries) collected over ten years from 109 screening clinics strongly demonstrated the experience of many BIPOC women when receiving medical care.¹⁹

However, the study had a few limitations. It excluded people for whom data was incomplete and facilities with low biopsy rates. Additionally, the research team could not precisely analyze or account for structural racism because it was not measured in the data.

Why these results matter

This study’s findings are consistent with earlier research exploring equity in medical care across the US.²⁰

The BIPOC community continues to struggle to receive equitable care. For example, BIPOC people over the age of 64 are less likely to receive regular medical care or have a primary care provider compared to White people of the same age. This situation potentially results in lower screening rates, worse health outcomes, and missed diagnoses.

Yet, despite systemic racism and socioeconomic factors creating barriers for the BIPOC community, research shows that Black people are more likely to follow screening instructions. According to the USPSTF, Black women are less likely than White women to miss a recommended mammogram (15% versus 22%).²¹

Genetic testing for suspected high-risk groups is another screening method that could help identify those who may need earlier or more frequent mammograms. However, data shows that Black people are less likely to be referred for genetic testing.²² ²³

Another concern is that Black and Hispanic people are not well represented in clinical trials.²⁴ This negatively impacts the development of targeted screening strategies and treatments.

Access to timely care matters

Biopsies are currently the gold standard for breast cancer diagnosis. A biopsy is a minimally invasive procedure that obtains cells for a pathologist to assess and analyze.

Delays in receiving a biopsy significantly increase your risk of poorer health outcomes, such as:²⁵

• Increased cancer growth and spread — Untreated cancer will grow and spread from one localized area to the surrounding lymph nodes and potentially around the body.

• Needing more aggressive treatments — Treating late-stage cancer involves more intensive chemotherapy, radiation, and surgery. These more aggressive treatments can be invasive and complex for patients to recover from.

• Worse treatment side effects — More invasive treatment options often cause more aggressive complications. As a result, finding ways to treat cancer while minimizing treatment effects can be difficult in late-stage cancer patients.

• Increased fear and anxiety — Receiving a cancer diagnosis at any stage is stressful and daunting, but this can only worsen for patients with more advanced cancer.

• Worse prognosis rate — Patients diagnosed with late-stage cancer are more likely to pass away from the disease than those diagnosed earlier.

How to better advocate for your care

BIPOC patients shouldn’t have to jump through hoops to receive the same level of care as their White counterparts.

But, until health injustices are corrected within the healthcare industry, women in the BIPOC community will, unfortunately, need to keep fighting for their right to timely care.

While this is unfair and exhausting, there are ways you can improve your chances of getting quality medical care. If you are due to receive a routine mammogram, you can follow these tips to advocate for your care and health outcomes:

• Stay educated about risk factors — Familiarizing yourself with breast cancer’s most common risk factors and symptoms is essential for early detection. Things like increased breast pain, nipple discharge, swelling, and dimpling of the breast skin are all common breast cancer symptoms to monitor for.²⁶

• Perform at-home breast exams — Regularly practice breast exams by feeling around your breast and armpit tissue for lumps and bumps. Inspect the tissue in a circular motion and report any changes to the texture of your breasts to your primary care provider for additional monitoring and testing.

• Ask for support — You can speak to a social worker or patient navigator at your facility if language or other communication barriers are causing difficulties in scheduling screening and diagnostic tests. They may arrange for you to work with a translator, for example.

• Call about your lab results — If you recently had a mammogram, call your primary care provider, even if they said they would contact you first. Asking for results gives you the power to advocate for a timely biopsy appointment if your results are irregular.

• Explore alternative payment options — Cancer screening procedures are expensive, especially for patients without health insurance. You can contact your hospital, local non-profits, and financial assistance programs to explore payment options for your biopsy. It may be possible to partially, if not entirely, cover the fee. Speak to your hospital’s financial department, as it may be able to help with out-of-pocket expenses. They may be able to help you transfer to a hospital system that offers access to safety-net care.²⁷

If you’re looking for financial support, The American Society of Clinical Oncology has a list of available financial aid programs.²⁸ Additionally, BreastCancer.org has a great list of charitable resources that can help people recently diagnosed with cancer.²⁹

The lowdown

Racially charged health inequities are a byproduct of systemic racism — a cultural and societal outcome that is unjust and unfair. Race and ethnicity have been shown to affect access to all aspects of cancer care, including lifesaving diagnostic biopsies.

As more studies uncover evidence that systemic racism plays a significant role in the BIPOC community’s health outcomes, more resources are needed to address these inequities and ensure timely access to cancer care for all.

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s). Have feedback? Email content@healthmatch.io.

References:

1. Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity (2022)

2. Cancer Stat Facts: Cancer Disparities | National Cancer Institute

3. Cancer statistics for African American/Black People 2022 (2022)

4. Common Cancer Types | National Cancer Institute

5. Breast Cancer Statistics, 2022 (2022)

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11. What Is Breast Cancer Screening? | Centers for Disease Control and Prevention

12. What Are The Risk Factors For Breast Cancer? | Centers for Disease Control and Prevention

13. Breast Biopsy: Procedure Types, What To Expect, & Results | National Breast Cancer Foundation

14. Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity (2022)

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20. Delays in Breast Cancer Diagnosis and Treatment by Racial/Ethnic Group (2006)

21. Key Data on Health and Health Care by Race and Ethnicity (2023)

22. Disparities in Genetic Testing and Care among Black women with Hereditary Breast Cancer (2020)

23. Genetic Counseling and Testing in African American Patients With Breast Cancer: A Nationwide Survey of US Breast Oncologists (2021)

24. Lack of Diversity in Clinical Trials: A Patient’s Guide | Lung Cancer Foundation of America

25. Barriers and explanatory mechanisms in diagnostic delay in four cancers – A health-care disparity? (2019)

26. What Are The Symptoms of Breast Cancer? | Centers for Disease Control and Prevention

27. Our Members by State | America’s Essential Hospitals

28. Financial Resources | Cancer.Net

29. Charitable Resources for People Diagnosed With Breast Cancer | Breastcancer.org

Claire Bonneau is a medical writer and certified trauma operating room nurse.