Transcription:
Breast Cancer and People of Color

Cheryl Martin (Host): During the COVID pandemic rage, breast cancer screening for people of color dropped drastically. Now, we're seeing some dire consequences. That and more about breast cancer coming up next.

This is Maimo Med Talk. I'm Cheryl Martin. And with me this episode is Dr. Donna Marie Manasseh, Chief of Breast Surgery at Maimonides Health. Welcome, doctor. Delighted to have you on.

Dr Donna Marie Manasseh: Thank you so much. Delighted to be here. Thank you for the invitation.

Cheryl Martin (Host): First, please talk about the impact of the COVID pandemic on the breast cancer screening rate for people of color. What are you seeing?

Dr Donna Marie Manasseh: Unfortunately, what we've seen as a result of the COVID pandemic is our screening has gone down. Traditionally, even before we had a pandemic, it was a struggle to get women in to do their screening. Nobody really likes to do screening, but it's necessary to prevent a bigger problem. Within the community of people of color, it's become even more so a problem with the COVID pandemic for fears that going into the hospital will increase their risk for developing COVID. So unfortunately, we've seen the numbers go down with respect to screening.

Cheryl Martin (Host): And how has this impacted rates of cancer when you do detect it?

Dr Donna Marie Manasseh: Well, for across all individuals, in particular people of color, the detection is now at later stages because the value of screening really is in finding something that's really early. And early means treatable and means cure. When somebody presents with a later stage, it's much more of a struggle and a fight to try to get them to the same place.

So, coming in later, when you say you feel a mass, and you don't come and get a mammogram for a while or you just don't do your regular screening for fears around COVID, often results in patients coming in when it's in a little bit more of an advanced stage. And now, we are forced to treat a disease that unfortunately is a little bit harder to treat.

Cheryl Martin (Host): Are you able to project what this means for the mortality rate from breast cancer among people of color?

Dr Donna Marie Manasseh: I suspect that the mortality rate will go up, because you're finding this disease at advanced stages. It's particularly alarming because women and people of color tend to have the types of breast cancers that are a little bit more aggressive. This would be the triple-negative variety. These breast cancers in particular require early diagnosis and treatment to get the best result and get a chance of a cure. And when you find these diseases at a later stage as opposed to the non-triple-negative types of breast cancer, it's definitely a lot harder to fight. There're a lot fewer treatments that are available compared to the other types of breast cancers. So, the group that really does need to get their screening done on a regular basis and especially come in if they feel or notice a difference in their breast exam, really are the ones that unfortunately not doing the screening and is going to be impacted the most.

Cheryl Martin (Host): We are now two plus years from the beginning of this COVID pandemic. Are you seeing people of color come back almost at the rate where they were coming before COVID?

Dr Donna Marie Manasseh: They are coming back slowly. There have been a lot of campaigns redirecting the importance of screening, kind of what we did in the very beginning, I guess, in the mammogram and mamography era. However, I think that we're about to hit the fall, so we'll have to see what happens when the concerns about flu and concerns about COVID rise again in particular with COVID. And people can start to get concerned that maybe they shouldn't be going out to the hospitals as much as they were before, which is where our screening is done. But screening doesn't necessarily be done just at a hospital. We do that at our free-standing breast center, which is not necessarily connected directly to the hospital. But any situation where there's going to be people gathered indoors can make people who are concerned about COVID nervous. But the numbers are going up, thankfully.

Cheryl Martin (Host): This disparity has been there probably since the very beginning. Identify some of the reasons for that.

Dr Donna Marie Manasseh: It's a tough situation because it's the things of the past that's unfortunately affecting the future. Traditionally and historically for good reason, people of color have not been treated well by the medical system. They've either been experimented on, the famous is the Tuskegee experiment or other situations that they've heard down the line in verbal stories from their ancestors and their relatives of why it actually isn't a good idea to be in the medical system and to not really trust the medical system.

This mistrust unfortunately continues and percolates today in various other situations. But unfortunately, because of this mistrust, they're less likely to go and get the screening that they need. They're less likely to try to do some of the therapies that are recommended. And they're not too far off with respect to mistrusting because, in some situations, there is a reasonable reason for why there is mistrust. We know that, especially when it comes to things like pain, that people of color often aren't given the appropriate pain medication compared to the white population. And so as a result, some of these fears and concerns get reaffirmed when they encounter a bad situation. Now, just like any other specialty, there're good versions of that particular specialty, and there're bad versions. And it's a shame if a bad version or bad experience kind of covers the entire experience and prevents that individual from getting what they really truly need.

Cheryl Martin (Host): What do you see as a solution then to this breast care challenge of educating people about the necessity for this, the benefit?

Dr Donna Marie Manasseh: I think the number one thing does come down to education. If you have suspicions, you have concerns about either the medical community that you are in or you have concerns about just what's going on with respect to COVID, you need to educate yourself on what actually are the true facts about this. And by education, I don't mean to kind of listen to what's on potentially some social media site or some particular internet site that may not be as reliable. Go to the sites, go to the places like the American Cancer Society, breastcancer.org, some of the places that really do value the information that they're trying to provide to their communities, and use that information to make the decisions for yourself. The fact is that the only way we can detect breast cancer early enough for it to be something that we can easily treat and be easily cured is really through screening. And that screening right now, even plus or minus some of its flaws, is mammography screening. It is the best way for us to pick something up in the breast as early as possible and give you the best result.

Cheryl Martin (Host): Has cost been a deterrent?

Dr Donna Marie Manasseh: Cost can be a deterrent, more so on the side that some individuals as a result of COVID have either lost their jobs or lost their insurances. But thankfully, there is always a way with a woman with a cancer diagnosis or a man with a cancer diagnosis to find some way to get treatment paid for. The hospitals are very well versed in this. Either the hospitals themselves have particular programs or there are other governmental programs that, if you have a diagnosis, we're going to find a way to treat you. Similarly, there are programs like mobile mammography vans. There are other programs for where screening can be free. So, there's always a way in this country for sure, that if you have no insurance or you don't have any way of paying for a screening test, there is some method where you can get that screening test paid for. And if, God forbid, you end up with a diagnosis, there is a way to get your treatment paid for.

Cheryl Martin (Host): Talk more about the treatment and the best tools today for treating breast cancer.

Dr Donna Marie Manasseh: The good thing about breast cancer is that we have not just one tool, but we have a magnitude of tools. Breast cancer has been studied enough where we have figured out that there's not just one disease, but multiple diseases when it comes to breast cancer. So, we generally try to target the best treatment for that particular cancer.

So depending on what type of cancer you have, what type of markers that the cancer demonstrates, we will target our tools in that direction. It used to be that we would only have surgery as an option, and then it moved where we had just one version of chemo. Now, we have a breadth of different types of chemotherapeutics, different types of endocrine therapies, different types of antibody type therapies and immunotherapies that really can target the specific tumor that you have. It's why the benefit of screening has become even more so important because if you have something, we find it, we can treat it. Sometimes you'll get to a stage where now the weapons that we have or the treatment options we have are now much more limited because of the stage that you are in. So, screening really does become important because it does impact the type of treatment you're going to end up getting.

Cheryl Martin (Host): Bring us up to date on if cancer is detected early, to what extent breast cancer does this really reduce your mortality rate? Or how long can you expect to live with the diagnosis of breast cancer?

Dr Donna Marie Manasseh: It's a hard question to answer with respect to living with a diagnosis. But I think the best way to think of it, and the way we have thought of it, is someone who's diagnosed in stage 0 or stage I, their chances of doing well with respect to longevity is in the 90th percentile. Somebody diagnosed in the stage III, stage IV, that number is significantly lowered.

I don't often like to use numbers with my patients because, number one, I'm not God, I have no idea in terms of the plan. We're going off of what we've seen in the data, what we've seen in observation, what we've seen in the literature as to what's the best type of treatment and what our most effective is. But it's no doubt that if you come in with a small, tiny little cancer that we pick up on mammogram, I take you to the operating room and it's small enough where you may not need chemotherapy or you may not need even a radiation therapy depending on how old you are and the type of tumor that it is. Whereas if you come in with something that you felt on an exam and we didn't really see it on a mammography, because we haven't had one in a while, then it becomes a harder thing to treat. But as I said, there's always caveats and there's always exceptions. So yes, you're going to have, as my patients will say, "Well, I know somebody where this happened and they were fine" or "I know somebody where this happened and they weren't fine." But these are just one off examples. What we've got to look at is the general population. Look at the literature and look at what we have found as a society in terms of the medical society, what we have found works the best for these particular scenarios.

Cheryl Martin (Host): So doctor, this is why it's even more important for the screenings to take place as early as possible because the earlier the cancer is detected, it increases the chances of longevity.

Dr Donna Marie Manasseh: It increases the chances of longevity. It decreases the toxicities that may be associated with the types of medication and treatments you'll have. You may require for something that's really early, just surgery, or you may require just surgery and a medication like a pill. Versus if it's a little bit more advanced or a little bit more aggressive or detected later, you may need chemotherapy or multiple rounds of chemotherapy.

We can't predict per se that there's some bad actors when it comes to types of breast cancer. And even if you do everything right, you do your screening and we still find something that requires a lot of treatment. Fine, it's what it is and luckily we have that treatment. However, if the chances are that if we find something early, it's better that you find something early so that we can treat you with less or fewer things than if we find something later that requires a lot more intensive therapy, then it's something worth trying.

Cheryl Martin (Host): Anything else you'd like to add on this whole topic of increasing the numbers of people of color coming in for their screening? What else can be done to encourage them to do that and to break this cycle?

Dr Donna Marie Manasseh: Honestly, I am a woman of color as well, so I understand the history and the fears behind it. I have family members that feel kind of the same way. The only thing I can say to that is it's your body, it's your life, and it's your family that will suffer if we don't get you the right treatment.

Thankfully, there are tons of breast practices, there are tons of breast specialists. So if you don't like the physician you're with, if you don't trust them, then go and see another one because it's important for you to have a great relationship with them because we need you to get the right treatment so you can go on and live a very productive life and be here for your family.

But not going to get a screening mammogram or screening test of any kind because of the concerns that are, I agree, legitimate, legitimate, really bad history when it comes to the treatment of people of color in the medical community, it's not worth it enough to sacrifice your own life and continue to sacrifice the lives of people of color by not doing the things that we now have the rights to actually.

Cheryl Martin (Host): Dr. Donna Marie Manasseh, thank you so much for your passion on this topic and also just shedding light on this critical issue. Thank you so much.

Dr Donna Marie Manasseh: Thank you and thank you for taking the time to speak with me. It's a really important topic and hopefully people will hear us.

Cheryl Martin (Host): If you want to make an appointment, call 718-765-7550. That's 718-765-7550. And for more information, go to maimo.org. That's maimo.org. If you found this information helpful, please share it with others on your social media. And thanks for listening to Maimo Med Talk.