Maggie McKay (Host): Welcome to The Pulse at Tallahassee Memorial Healthcare. I'm your host, Maggie McKay. Dealing with breast cancer in minority and underserved populations can look very different than in other regions. So today, breast surgical oncologist, Dr. Shea Everidge, is going to explain the differences, like why rates are higher, and some barriers that need to be changed among other things. Thank you so much for being here, Dr. Everidge.

Shlermine "Shea" Everidge, MD: Thank you for having me.

Host: Let's just dive right in. Breast cancer can affect anyone, but research shows that women in minority, rural, and underserved communities often face higher risks and worse outcomes. So, what are some of the key reasons behind that?

Shlermine "Shea" Everidge, MD: So, you're right. Particularly speaking to black women, they are less likely to be diagnosed with breast cancer, but their outcomes tend to have a worse prognosis, specifically because though that population also has a higher risk of developing triple-negative breast cancer. That's the type of breast cancer that holds the worst prognosis.

A lot of that has to do with lack of access to care, lack of screening, almost lack of education of knowing when to screen and what breast cancer is even. We're in a place now where screening mammograms catch the majority of breast cancers that are diagnosed now. And the goal is to catch breast cancer early. So if these patients are lacking access to care, access to the screening that they need, or just don't even know that they should be screening at a certain age, we're catching these later when these kind of grow out of hand.

Host: So, what kind of barriers do patients in these communities face when it comes to early detection and diagnosis and treatment?

Shlermine "Shea" Everidge, MD: So, it can be something as big as, you know, not having access to a doctor, not having a primary care to order their mammograms, not being able to get there. We think about transportation. Sometimes in these rural areas, people don't have access to a local mammogram facility, or they can't have access to their doctor to even start that process. We talk about when we get to the treatment regimen of breast cancer, patients don't have access to radiation going there every day.

One of the biggest access issues we have is insurance. Patients might not have insurance or they might be underinsured, meaning their insurance can be a little bit difficult. You know, we've run into issues where patients have insurance, but their insurance provides coverage in 50 miles over, and not necessarily coverage in their local city. So, it's smaller things like that that we don't necessarily think about all the time.

Host: That's huge if you're the one with breast cancer. And what about transportation? Is that an issue as well? Maybe people can't get there.

Shlermine "Shea" Everidge, MD: That's always an issue. In rural places, even in, you know, larger cities, it's always an issue. whether that means not having a car. Maybe in that area, there's limit to public or limitations to public transportation as well. So, in a bigger city, you might still have the bus or train, taxi. Some patients can't afford that. And some patients, that service isn't even offered where they live.

Host: Thankfully, you help lead a comprehensive breast cancer program, the Walker Breast Program at the Tallahassee Memorial Cancer Center. Can you walk us through what that is and how it helps break down some of these barriers?

Shlermine "Shea" Everidge, MD: Yeah. So, it is a multidisciplinary, meaning all the disciplines that interact with breast cancer, a multidisciplinary team of doctors who come together to work together to fight breast cancer. And so, how it works is we see a patient, I'm usually their first point of contact. We go through their case with this multidisciplinary team, meaning we review all their imaging, all their pathology. The medical oncologist is there to weigh in on their type of breast cancer, so is the radiation . People who your access would be restricted to, and you kind of meet them on the back end, you're meeting all these people on the front end so that we can kind of create a tailored breast cancer treatment for that patient.

It does limit the need for multiple doctor's visits prior to getting a treatment plan in place. So, all in one building, if you need to speak to the radiation oncologist, they're there. Same thing with the medical oncologist. Because sometimes surgery isn't the first line of treatment, so it's important to talk to the medical oncologist to talk about potentially chemo and things like that. It reduces the fragmentation that can sometimes come with multiple doctor's visits.

Host: And as we mentioned a little bit, access is a big challenge for a lot of patients. So, how does the Walker Breast Program support women who may not have easy access to transportation, insurance, or specialty care? I know you answered it somewhat, but a little more in depth.

Shlermine "Shea" Everidge, MD: Yeah. We have an amazing group of navigators, led by Amy Anderson, our navigator extraordinaire. This is your point of contact for the patient for all things pretty much non-medical, but things that can limit access to medical treatment, specifically for breast cancer. This person can help with things from insurance coverage, getting insurance, making sure insurance covers certain things, making sure you have a ride, sometimes getting a taxi even, things like that. So, I think that a good navigation team is key for good breast program.

Host: There's also a trust gap between some patients and the healthcare system. It can exist, especially those in historically marginalized groups. So, how do you and your team work to build trust and meet patients where they are?

Shlermine "Shea" Everidge, MD: Yes. So, you're definitely right. Historically, a lot of mistrust towards the medical field from marginalized patients, specifically black patients as well. And I think that diversifying the field of medicine period is definitely the way to kind of bridge that gap a little bit. So, definitely diversifying. You know, a patient feels a little more comfortable when they're seeing someone that looks like them. And not to necessarily to mean that, you know, I give better care than my partner or anything like that, but just kind of to help with the comfort, making patients feel a little more at ease, being able to meet all the people that are going to be helping you through this really sensitive topic, and making sure you just spend the time with patients.

My biggest thing is education. I don't care what walk of life you're coming from. I'm going to sit there and tell you about every detail about your breast cancer in a way that's not intimidating, in a way that you didn't have to go to med school to understand, but just to make sure before you know, you allow me to do something so sensitive to you, you understand the reasons behind that.

Host: That's awesome. Well, beyond the medical side of cancer care, how important are things like patient navigation, mental health support, and financial counseling? How are those integrated into the Walker Breast Program?

Shlermine "Shea" Everidge, MD: Yes. So through our navigation program, all those things, kind of we have a team of counselors through that navigation system as well for the mental health portion of that. Our billing department helps to kind of make sure everything's authorized so that no surprise billings pop up with patients that are going through this. For unfunded patients, the TMH Foundation has done a great job helping to make these things that are unaffordable for some affordable. And for those patients who truly just can't or don't have the insurance, covering essential things like MRIs and biopsies,

Host: There's so much involved that people don't even think about or know until they're in it, right? If someone listening is worried about their own breast health or knows someone in an underserved area who might be at risk, what would you want them to know about the support that's available?

Shlermine "Shea" Everidge, MD: It's everywhere. You just have to look for it. It sometimes does feel like you're out in an island when you're dealing with something, but someone around you very likely has dealt with something similar. So, ask questions. If there's any problem with your breast, talk to a doctor, pick up the phone, call someone and someone will pull you in to get a mammogram, be seen, just get the ball rolling.

Host: Anything else you'd like to add in closing that maybe we didn't cover?

Shlermine "Shea" Everidge, MD: Not necessarily that we didn't cover, but if I haven't stressed it enough, please, please, please go get your mammogram if you have a high risk history, meaning you have a family just riddled with breast cancer or ovarian cancer, please let your doctor know. Some of these patients are considered even more high risk and may require special screening, maybe earlier screening. So, those are all reasons to talk to a breast specialist to make sure we can catch a cancer early.

Host: Thank you so much for sharing your expertise today. We really appreciate it. This has been so informative.

Shlermine "Shea" Everidge, MD: Oh, thank you. Thank you for having me. I appreciate being able to come on this podcast.

Host: Absolutely. Again, that's Dr. Shea Everidge. Learn more about how the Tallahassee Memorial Cancer Center provides the highest quality breast cancer care in the region at tmh.org/breastcancer. That's tmh.org/breastcancer. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to The Pulse at Tallahassee Memorial Healthcare.