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Guideline-concordant diagnostic workup, locoregional treatment, and initiation of systemic therapy were defined using NCCN guidelines. Hazards of breast cancer death 2 and 5\u00a0years from diagnosis by each guideline-concordance outcome overall and stratified by race and ethnicity were estimated using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Non-concordant diagnostic workup, locoregional treatment, and systemic therapy initiation were each associated with increased hazards of 2- and 5-year breast cancer mortality (diagnostics HR\n                      <jats:sub>2-year<\/jats:sub>\n                      (95% CI) 1.33 (1.25\u20131.41), HR\n                      <jats:sub>5-year<\/jats:sub>\n                      1.29 (1.23\u20131.35); locoregional HR\n                      <jats:sub>2-year<\/jats:sub>\n                      2.10 (1.98\u20132.23), HR\n                      <jats:sub>5-year<\/jats:sub>\n                      1.83 (1.76\u20131.90); systemics HR\n                      <jats:sub>2-year<\/jats:sub>\n                      1.67 (1.51\u20131.84), HR\n                      <jats:sub>5-year<\/jats:sub>\n                      1.56 (1.45\u20131.68)). Non-concordant diagnostic workup and systemic therapy initiation were associated with greater hazard of 2- and 5-year breast cancer death among Black, Asian\/Pacific Islander, Hispanic White, and non-Hispanic White patients; there was no consistent association among American Indian\/Alaska Native patients for either outcome. Locoregional treatment was strongly associated with hazards of cancer death for all groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Equitable delivery of guideline-recommended breast cancer care from diagnosis through treatment across racial and ethnic groups may mitigate survival disparities. Efforts to improve access to high-quality care must be informed by and responsive to the social and structural root causes of health inequities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10552-025-02099-9","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T08:10:13Z","timestamp":1768983013000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Guideline-concordance along the cancer care continuum and breast cancer mortality by race and ethnicity: a SEER-Medicare study"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4090-9174","authenticated-orcid":false,"given":"Emma L.","family":"Herbach","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M.","family":"Carnahan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren E.","family":"McCullough","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley D.","family":"McDowell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michaela","family":"Curran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid M.","family":"Lizarraga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary E.","family":"Charlton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah H.","family":"Nash","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"2099_CR1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21754","author":"AN Giaquinto","year":"2022","unstructured":"Giaquinto AN, Sung H, Miller KD et al (2022) Breast cancer statistics, 2022. 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