Inequalities in routes to diagnosis, time to diagnosis and time to treatment among adults diagnosed with breast cancer in England: a nationwide population-based study of diagnoses between 2009 and 2018

Abstract Background In England, people from marginalised groups are more likely to be diagnosed with, and treated for, late-stage breast cancer. Differences in routes to diagnosis, time to diagnosis and time to treatment may be contributing factors. Methods Data from the Clinical Practice Research Datalink and the Cancer Registration Tumour and Treatment datasets were assessed for 86,564 adults diagnosed between 01 January 2009 and 31 December 2018. Associations between patient characteristics and route to diagnosis, time to diagnosis and time to treatment were examined using logistic regression and accelerated failure time models. Results People of Asian (aOR: 0.87, CI 0.79, 0.97), Black (aOR: 0.71, CI 0.62, 0.82), or Mixed ethnicity (aOR: 0.67, CI 0.51, 0.88), those experiencing deprivation (aOR: 0.89, CI 0.85, 0.95), and those with severe mental illness (aOR: 0.87, CI 0.78, 0.98) were less likely to be diagnosed via screening. Conversely, these groups were more likely to be diagnosed via urgent suspected cancer referral and/or emergency presentation. Time to diagnosis was longer for people with a learning disability (aTR: 1.18, CI 1.06, 1.32), while time to treatment was longer for people with a learning disability (1.08, CI 1.03, 1.13), people with severe mental illness (aTR: 1.07, CI 1.04, 1.09) and people of Black (aTR: 1.10, CI 1.07, 1.13) or Other ethnicity (aTR: 1.06 CI 1.03, 1.10). Conclusions This study provides insights into which patient groups experience inequalities in routes to diagnosis, time to diagnosis and time to treatment. The findings can be used to target strategies to reduce inequalities in stage at diagnosis and treatment.