{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:27:00Z","timestamp":1780572420341,"version":"3.54.1"},"reference-count":21,"publisher":"Wiley","issue":"19","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"am","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009898","name":"Defense Health Agency","doi-asserted-by":"publisher","award":["HU0001\u201021\u20102\u20100089"],"award-info":[{"award-number":["HU0001\u201021\u20102\u20100089"]}],"id":[{"id":"10.13039\/100009898","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast cancer is the most diagnosed cancer among women in the United States, and early identification and initiation of treatment are critical to improving outcomes. This study aims to investigate the breast cancer time to treat trends among women in the Military Health System before and during the COVID\u201019 pandemic and if racial or socioeconomic disparities existed in timely treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study of all female MHS beneficiaries ages 18\u201363\u2009years during fiscal years 2018\u20132022. Incident breast cancer was defined as one inpatient or three outpatient diagnoses of breast cancer within a 90\u2010day period and no previous breast cancer diagnosis in the 3\u2009years prior. Time to treatment was calculated in days and timely treatment was identified if received within 90\u2009days (surgical intervention) or 120\u2009days (chemotherapy and radiation) after initial diagnosis. Study analyses included a\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test and Kaplan\u2013Meier curve for time to treatment and an adjusted modified Poisson regression for the relative risk of timely treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A cohort of 14,286 women with incident breast cancer was identified; 94% received timely treatment. The average time to treatment was greater during the pandemic period (47.7\u2009days, 95% CI\u2009=\u200946.6\u201348.7) compared to the pre\u2010pandemic period (44.8\u2009days, 95% CI\u2009=\u200943.7\u201345.9). Regression results indicated no difference in the likelihood of timely treatment in the pandemic period (0.99 aRR, 0.98\u20131.01 95% CI), no racial or socioeconomic disparities, and timely treatment was more likely to be received in the direct care setting (aRR\u2009=\u20091.04, 95% CI\u2009=\u20091.01\u20131.07).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite facing access to care challenges compounded by the COVID\u201019 pandemic, the MHS was able to provide timely treatment to women for incident breast cancer. In addition, this study observed no racial or socioeconomic disparities in the timely treatment of breast cancer in a population with equal access to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71292","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T23:37:23Z","timestamp":1759793843000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of\n                    <scp>COVID<\/scp>\n                    \u201019 on Time to Treat Breast Cancer and Racial Disparities Among Women in the Military Health System From\n                    <scp>FY2018<\/scp>\n                    \u20102022"],"prefix":"10.1002","volume":"14","author":[{"given":"Melody F.","family":"Mullin","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics Uniformed Services of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6660-1229","authenticated-orcid":false,"given":"Amanda","family":"Banaag","sequence":"additional","affiliation":[{"name":"Center for Health Services Research Uniformed Services of the Health Sciences  Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Coles","sequence":"additional","affiliation":[{"name":"Center for Health Services Research Uniformed Services of the Health Sciences  Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9077-4688","authenticated-orcid":false,"given":"Yvonee","family":"Eaglehouse","sequence":"additional","affiliation":[{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"},{"name":"Murtha Cancer Center Research Program, Department of Surgery Uniformed Services University of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangmin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics Uniformed Services of the Health Sciences  Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.  Bethesda Maryland USA"},{"name":"Murtha Cancer Center Research Program, Department of Surgery Uniformed Services University of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey P.","family":"Koehlmoos","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Biostatistics Uniformed Services of the Health Sciences  Bethesda Maryland USA"},{"name":"Center for Health Services Research Uniformed Services of the Health Sciences  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21708"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21754"},{"key":"e_1_2_11_4_1","volume-title":"American Cancer Society Recommendations for the Early Detection of Breast Cancer","author":"American Cancer Society","year":"2023"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010009\u20100729\u20105"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010016\u20105486\u20107"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010018\u20106615\u20102"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usab506"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33180"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.5113"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usad218"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6487"},{"key":"e_1_2_11_13_1","unstructured":"Defense Health Agency Solution Delivery Division \u201cMilitary Health System Data Repository [Fact Sheet] \u201d(2019) https:\/\/health.mil\/Reference\u2010Center\/Fact\u2010Sheets\/2019\/04\/05\/Military\u2010Health\u2010System\u2010Data\u2010Repository."},{"issue":"7","key":"e_1_2_11_14_1","first-page":"23","article-title":"Incident Diagnoses of Cancers in the Active Component and Cancer\u2010Related Deaths in the Active and Reserve Components, U.S. Armed Forces, 2005\u20102014","volume":"23","author":"Lee T.","year":"2016","journal-title":"MSMR"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.05.008"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/antiox12040904"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106559"},{"key":"e_1_2_11_18_1","volume-title":"Evaluation of Department of Defense Military Medical Treatment Facility Challanges During the Coronavirus Disease 2019 (COVID\u201019) Pandemic in Fiscal Year 2021. (DODIG\u20102022\u2010081)","author":"Deparment of Defense Inspector General","year":"2022"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199411000-00017"},{"issue":"13","key":"e_1_2_11_20_1","article-title":"The Influence of Musculoskeletal Conditions, Behavioral Health Diagnoses, and Demographic Factors on Injury\u2010Related Outcome in a High\u2010Demand Population","volume":"96","author":"Schoenfeld A. J.","year":"2014","journal-title":"Journal of Bone and Joint Surgery. 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