{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:09:36Z","timestamp":1793297376127,"version":"4.5.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004500","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T00:00:00Z","timestamp":1734307200000}}],"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Cancer Institute","award":["T32 CA116339"],"award-info":[{"award-number":["T32 CA116339"]}]},{"name":"Susan G. Komen Foundation","award":["OGUNC1202; OG22873776; SAC210102; TREND21686258;"],"award-info":[{"award-number":["OGUNC1202; OG22873776; SAC210102; TREND21686258;"]}]},{"name":"National Cancer Institute","award":["R01CA253450; P50-CA058223"],"award-info":[{"award-number":["R01CA253450; P50-CA058223"]}]},{"DOI":"10.13039\/100001006","name":"Breast Cancer Research Foundation","doi-asserted-by":"publisher","award":["HEI-23-003"],"award-info":[{"award-number":["HEI-23-003"]}],"id":[{"id":"10.13039\/100001006","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["HT94252310235"],"award-info":[{"award-number":["HT94252310235"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Cancer Institute","award":["P30CA016086"],"award-info":[{"award-number":["P30CA016086"]}]},{"name":"National Cancer Institute","award":["P30CA016080"],"award-info":[{"award-number":["P30CA016080"]}]},{"name":"UNC-CH University Cancer Research Fund"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>The Carolina Breast Cancer Study (CBCS) Phase 3 is a population-based, case-only cohort (<jats:italic>n<\/jats:italic> = 2,998, 50% black) of patients with invasive breast cancer diagnoses (2008 to 2013). We used latent class analysis (LCA) to group participants based on patterns of factors within 3 separate domains: socioeconomic status (\u201cSES\u201d), \u201ccare barriers,\u201d and \u201ccare use.\u201d These classes were evaluated in association with delayed diagnosis (approximated with stages III\u2013IV at diagnosis), delayed treatment initiation (more than 30 days between diagnosis and first treatment), prolonged treatment duration (time between first and last treatment\u2013by treatment modality), and receipt of OncotypeDx genomic testing (evaluated among patients with early stage, ER+ (estrogen receptor-positive), HER2- (human epidermal growth factor receptor 2-negative) disease). Associations were evaluated using adjusted linear-risk regression to estimate relative frequency differences (RFDs) with 95% confidence intervals (CIs). Delayed diagnosis models were adjusted for age; delayed and prolonged treatment models were adjusted for age and tumor size, stage, and grade at diagnosis; and OncotypeDx models were adjusted for age and tumor size and grade.<\/jats:p>\n<jats:p>Overall, 18% of CBCS participants had late stage\/delayed diagnosis, 35% had delayed treatment initiation, 48% had prolonged treatment duration, and 62% were not OncotypeDx tested. Black women had higher prevalence for each outcome. We identified 3 latent classes for SES (\u201chigh SES,\u201d \u201cmoderate SES,\u201d and \u201clow SES\u201d), 2 classes for care barriers (\u201cfew barriers,\u201d \u201cmore barriers\u201d), and 5 classes for care use (\u201cshort travel\/high preventive care,\u201d \u201cshort travel\/low preventive care,\u201d \u201cmedium travel,\u201d \u201cvariable travel,\u201d and \u201clong travel\u201d) in which travel is defined by estimated road driving time. Low SES and more barriers to care were associated with greater frequency of delayed diagnosis (RFD<jats:sub>adj<\/jats:sub> = 5.5%, 95% CI [2.4, 8.5]; RFD<jats:sub>adj<\/jats:sub> = 6.7%, 95% CI [2.8,10.7], respectively) and prolonged treatment (RFD<jats:sub>adj<\/jats:sub> = 9.7%, 95% CI [4.8 to 14.6]; RFD<jats:sub>adj<\/jats:sub> = 7.3%, 95% CI [2.4 to 12.2], respectively). Variable travel (short travel to diagnosis but long travel to surgery) was associated with delayed treatment in the entire study population (RFD<jats:sub>adj<\/jats:sub> = 10.7%, 95% CI [2.7 to 18.8]) compared to the short travel, high use referent group. Long travel to both diagnosis and surgery was associated with delayed treatment only among black women. The main limitations of this work were inability to make inferences about causal effects of individual variables that formed the latent classes, reliance on self-reported socioeconomic and healthcare history information, and generalizability outside of North Carolina, United States of America.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Black patients face more frequent delays throughout the care continuum, likely stemming from different types of access barriers at key junctures. Improving breast cancer care access will require intervention on multiple aspects of SES and healthcare access.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1004500","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T19:01:31Z","timestamp":1733166091000},"page":"e1004500","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["A latent class assessment of healthcare access factors and disparities in breast cancer care timeliness"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7618-4983","authenticated-orcid":true,"given":"Matthew 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Alsten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9908-910X","authenticated-orcid":true,"given":"Mya L.","family":"Roberson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie B.","family":"Wheeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Carey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Hyslop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8550-6195","authenticated-orcid":true,"given":"Jennifer","family":"Elston Lafata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa 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