Breast Cancer Care in U.S. Territories Seems to Lag Behind Care in Continental United States

Get Permission

“Inferior breast cancer care in U.S. territories is particularly concerning, given that our study focused on a time period prior to Hurricane Maria.”
— Cary Gross, MD

Tweet this quote

OLDER WOMEN residing in U.S. territories are less likely to receive recommended or timely care for breast cancer compared with similar women residing in the continental United States, according to Yale researchers, whose findings were published in Health Affairs.1 

“Inferior breast cancer care in U.S. territories is particularly concerning, given that our study focused on a time period prior to Hurricane Maria,” said Cary Gross, MD, Professor of Medicine at Yale School of Medicine and senior author of the study. “Our findings suggest that efforts to address the devastating impact of the hurricane on the citizens and health-care infrastructure of the Caribbean territories need to focus on making the system better than it was.” 

Key Study Findings 

USING MEDICARE claims data from 2008 to 2014, the researchers analyzed breast cancer care for women in the U.S. territories, including American Samoa, the Northern Mariana Islands, Guam, U.S. Virgin Islands, and Puerto Rico. Compared with women living in the continental United States, women in these territories who had surgical treatment for breast cancer were significantly less likely to receive other recommended care, the researchers found. In the period preceding surgery, women in the territories had 24% lower odds of receiving diagnostic needle biopsy. Following breast-conserving surgery, they were less likely to receive radiation therapy, noted the researchers. 

These women also experienced significant delays in receiving timely care. The researchers noted that 1 month after diagnosis, 42% of women in the U.S. territories had breast surgery, compared with 63% of women in the continental United States. For women in the territories who received breast-conserving surgery, 41% also received radiation therapy, vs 77% of those in the continental United States. 

The U.S. territories are home to nearly 5 million people; the majority identify as racial or ethnic minorities. By law, residents of the territories are U.S. citizens, yet federal funding for Medicare in the territories is substantially lower than in the continental United States, limiting resources for health-care services, including breast cancer care. 

DISCLOSURE: For full disclosures of the study authors, visit 


1. Layne TM, Aminawung JA, Soulos PR, et al: Quality of breast cancer care in the US territories: Insights from Medicare. Health Aff (Millwood) 37:421-428, 2018.