Surgeons can play a key role in reducing breast cancer disparities by increasing their awareness of where disparities exist and having open conversations with their patients about their needs to initiate referrals early on in their care, according to a new collective review article published in the Journal of the American College of Surgeons (JACS).
Despite improved screening and treatment options for breast cancer — the most common cancer diagnosed in women excluding skin cancers — many populations face significant barriers to screening and treatment options for breast cancer.
Following a well-received in-person panel discussion on breast cancer disparities held at the American College of Surgeons (ACS) Clinical Congress in October 2022, an interdisciplinary team of clinicians, which included surgeons, a radiologist, and public health researchers, convened to explore these disparities in more detail for a research article in JACS.
“Many breast surgeons may already be aware of some of the disparities that exist in regard to breast cancer care, but we wanted to illustrate the wide scope of the problems and raise awareness among general surgeons and other healthcare providers who treat breast cancer patients,” said Kathie-Ann Joseph, MD, MPH, FACS, senior author of the study and a professor of surgery and population health at New York University (NYU) Langone Health. “Whether you work in a rural or city hospital, these are real issues that we deal with and face every day.”
While disparities are multifactorial, the researchers identified four specific areas where disparities remain concerning: screening, genetic testing, reconstruction, and access to fertility-preservation treatments for cancer patients (also known as oncofertility).
“These are topics that are often overlooked. We sort of assume that most women who are diagnosed with breast cancer may require these services and that they are readily available. But unfortunately, depending on geography or the type of hospital that a patient is being treated, many of these services may not be available,” explained Dr Joseph, who also serves as vice-chair for diversity and health equity at NYU Langone Health. “Or if they are available, certain patients may not have the full breadth of access for some of these services or treatments.”
“There are differences in what screening services are offered, so I think we need to be asking: How do we make sure that people have equal access to the latest technologies so that they can anticipate the same great outcomes that other women can have?,” said Angelena Crown, MD, FACS, first author of the study and a breast surgeon at Swedish Cancer Institute in Seattle, Washington. “If we can find more cancers at an earlier stage, then we can really start seeing improvements, not only in survival but also in the quality of life associated with the treatments that are required for more advanced breast cancers.”
“I think there is a need for patient and clinician education about the importance of genetic testing for breast cancer prevention, screening, and targeted therapies,” said Allison Kurian, MD, MSc, a study co-author and professor of medicine and population health at Stanford Medicine. “It is also important for surgeons to recognise the unequal burden of VUS results. Surgeons should be ready to explain the implications of VUS results to patients and refer them to additional genetic counselling when appropriate.”
“It’s really important for providers to think about the quality of life that these women are going to have. Most of these women are going to be diagnosed with curable disease, meaning anything less than stage 4, and they are expected to have long, healthy lives,” Dr Crown said.
“Oftentimes, having a tissue-based reconstruction is ideal for many patients but that may not be feasible, depending on the type of training the plastic surgeon has, and the availability of the procedure at a specific hospital,” Dr Joseph explained.
Language and health literacy barriers can further impact the information available to a patient.
Recognising the magnitude of these disparities, the researchers outlined key steps that breast cancer centres and surgeons can take to improve equitable care:
Surgeons are often the first point of contact in a patient’s journey through breast cancer.
Surgeons can be important drivers of change, the authors noted, by maintaining their awareness of existing disparities and providing additional resources to patients when possible.
“One way to make a difference today is to be aware that access to breast cancer services is sub-optimal in many places, and that if you help your individual patients get access to necessary screening or treatment, you are already doing something good,” Dr Crown said. “By initiating conversations early, surgeons can actually expedite patient care and give patients access to more options. We can really shape what that future life looks like for patients starting right there on day one in the office.”
“Finding small ways to help address disparities, even if it’s just referring a patient for one programme that they would not have known about before, can make a huge difference for all our patients who are diagnosed with breast cancer,” Dr Joseph added. “It just starts with that one small step. There is hope, but it requires work.”
Study co-authors are Soudabeh Fazeli, MD, MPH and Daniela A Ochoa, MD, FACS.
Source: American College of Surgeons