There's a difference in healthcare delivery for breast cancer among women living in the continental United States and women living in the territories of the United States.
Women living in the territories of the United States are less likely to receive timely diagnosis and treatment for breast cancer compared to women living in the continental U.S
, according to recent research at Yale University.
‘According to this research, women who live in the territories of the United States are less likely to receive recommended or timely care for breast cancer compared with similar women residing in the continental United States.’
Using Medicare claims data from 2008 to 2014, the researchers analyzed breast cancer
care for women in the U.S. territories, including American Samoa, the Northern Mariana Islands, Guam, U.S. Virgin Islands, and Puerto Rico. Compared to women living in the continental United States (defined as 48 contiguous states, Alaska, and the District of Columbia), women in these territories who had surgical treatment for breast cancer were significantly less likely to receive other recommended care, the researchers said.
In the period preceding surgery, women in the territories had 24 percent lower odds of receiving diagnostic needle biopsy. Following breast conserving surgery, they were less likely to receive radiation therapy
, noted the researchers.
These women also experienced significant delays in receiving timely care. For example, one month after diagnosis, 42 percent of women in the U.S. territories had breast surgery, compared to 63 percent of women in the continental United States. For women in the territories who received breast-conserving surgery, 41 percent also received radiation therapy, compared to 77 percent of those in the continental United States.
"The pronounced inequality in breast cancer care for women in the territories demonstrates the importance of research focused on this understudied U.S. population," said Tracy Layne, first author, who contributed to the project as part of her doctoral training at the Yale School of Public Health.
The U.S. territories are home to nearly 5 million people; the majority identify as racial or ethnic minorities. By law, residents of the territories are U.S. citizens (except for those living on American Samoa). However, federal funding for Medicare in the territories is substantially lower than in the continental United States, limiting resources for healthcare services, including breast cancer care, said the researchers.
"Inferior breast cancer care in U.S. territories is particularly concerning, given that our study focused on a time period prior to Hurricane Maria," said Cary Gross, M.D., professor of medicine at Yale School of Medicine and senior author of the study. "Our findings suggest that efforts to address the devastating impact of the hurricane on the citizens and healthcare infrastructure of the Caribbean territories need to focus on making the system better than it was." Gross is a member of Yale Cancer Center.