Delays in care can impact patient satisfaction and survival outcomes. There are no studies in the literature evaluating the care continuum in veterans with breast cancer. A study of this predominantly African American female veteran population will help us understand barriers to care in this population.
A retrospective review of 87 patients diagnosed with breast cancer in the year 2021 at the Atlanta VA Medical Center was conducted to assess current care patterns as well as disease characteristics. Patients were included if their initial diagnostic evaluation and therapy for stage I-III breast cancer was at the Atlanta VA. Patients with a history of noncompliance causing delays in care were excluded from analysis. A total of 20 patients were identified for final analysis.
Veterans were predominately African American (85%). Median age was 61 years. Stage at presentation was as follows: stage 1(35%) stage II (30%) and stage III (35%). Receptor status was as follows: hormone receptor positive (35%), Triple negative (35%), and HER-2/neu positive (30%). Genetic testing and genomic assays were completed in 100% of eligible patients per NCCN guidelines. Lumpectomy was performed in 44% of cases and mastectomy in 55% of cases. 40% of cases where mastectomy was performed were done for patient preference alone. Median time for various phases of care were as follows: symptomatic presentation to diagnostic imaging 48 days (range, 7-146), abnormal screening mammogram to diagnostic mammogram 6 days (range, 0-74), diagnostic imaging to diagnostic biopsy 15.5 days (range, 0-43), diagnostic biopsy to initiation of neoadjuvant systemic therapy 22 days (range, 14-31), diagnosis or completion of neoadjuvant systemic therapy to breast cancer surgery 58 days (range, 15-113), and surgery to initiation of adjuvant chemotherapy 33 days (range, 14-44).
In comparison to national statistics there was a higher incidence of HER-2/neu positivity (15% vs 30%) and triple negative (12% vs 35%) subtypes, highlighting the need for quicker diagnostic testing. The delay from symptomatic presentation to diagnostic mammogram and biopsy necessitates a response given that high-risk presentations account for 75% of the cases. These findings demonstrate the need for in-house mammography to care for this high-risk minority veteran population.