The impact of social drivers of health on delayed time to breast cancer surgery.

BACKGROUND

Timely surgical treatment is critical for optimal breast cancer (BC) outcomes, yet delays in care persist. This study examined associations between social drivers of health (SDOH), race/ethnicity, and delayed BC surgery in New York City, stratified by surgery type.

METHODS

We conducted a retrospective analysis of BC cases diagnosed between 2007 and 2021 using INSIGHT Clinical Research Network data. Neighborhood-level SDOH, including household income, unemployment, percent of non-English speakers, and high school completion, were evaluated in relation to delayed surgery (>60 days from diagnosis). Multivariable logistic regression assessed associations between (1) SDOH and (2) race/ethnicity and delay of BC surgery, adjusting for confounders.

RESULTS

Surgical delay occurred in 10.7% of lumpectomy and 25.3% of mastectomy patients. For lumpectomy, delays were more likely in neighborhoods with the highest non-English-speaking (OR = 1.37, 95%CI = 1.12-1.68) and higher unemployment quartiles (OR = 1.49, 95%CI = 1.22-1.82) and less likely in the highest income (OR = 0.69,95%CI = 0.56-0.84) and education quartiles (OR = 0.60, 95%CI = 0.49-0.74). Mastectomy showed similar patterns. Delays were more frequent among Non-Hispanic Black (lumpectomy OR = 2.23; mastectomy OR = 1.82) and Hispanic patients (OR = 1.64; OR = 1.39).

CONCLUSION

This large, multi-institutional study reveals persistent disparities in timely surgical care. Nearly 15% experienced delays, with higher odds among Non-Hispanic Black, Hispanic, and socioeconomically disadvantaged patients, underscoring the need for equity-focused interventions.