Transcription:
Addressing Breast Cancer Care Disparities Within Diverse Populations

Melanie Cole:  Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And I invite you to listen as we discuss the importance of early detection and diagnosis, breast health issues within minority populations and help close those disparities and the approach to care at Weill Cornell Medicine. Joining me in this panel are my guests, Dr. Lisa Newman, she's the Chief of Breast Surgery at New York Presbyterian Weill Cornell Medical Center and a professor of surgery at Weill Cornell Medicine. And Dr. Vivian Bea, she's the Chief of Breast Surgical Oncology for New York Presbyterian Brooklyn Methodist Hospital and an assistant professor of surgery at Weill Cornell Medicine. Doctors, thank you so much for joining us for this really important topic.

And Dr. Newman, I'd like to start with you. Across the board, various ethnic groups have faced a disproportionate health burden. Speak to us a little bit about the unique challenges these communities have faced in terms of healthcare disparities. And specifically today, we're talking about breast health, does this strike all racial and ethnic groups equally? And tell us why you feel these disparities exist.

Dr. Lisa Newman: Breast cancer is a major problem and risk that's faced by all women. And here in the United States, we see a much higher breast cancer burden than communities in other parts of the world. But even here within the United States, we see differences in the incidence and the death rates from breast cancer for different population subsets. In particular, we see notably higher breast cancer mortality rates, breast cancer death rates in African-American women compared to white American women.

And there are many explanations for this breast cancer disparity. Socioeconomics is a huge issue with poverty rates and lack of insurance being higher in the African-American community compared to others that definitely leads to problems with accessing the healthcare system and, for breast cancer, it results in delays in a cancer diagnosis, inadequate treatment tragically for a lot of women. And that certainly accounts for some degree of the disproportionate death rates.

But we do also see differences in breast tumor biology for black women compared to white women. And African-American women are more likely to be diagnosed with some of the biologically more aggressive patterns of breast cancer. Black women are also more likely to be diagnosed with breast cancer at younger ages. So we need to conduct a lot more research regarding the explanations for these biologic factors that are related to breast cancer outcome.

Interestingly, we also see higher rates of breast cancer in men that have African-American background compared to in white American men. All of us need to be cognizant of breast cancer risk factors, men and women, and especially African-American men. So Vivian, I'd like to hear your impressions. Vivian practices in the very beautifully diverse Brooklyn community and you see a lot of these disparities firsthand.

Dr. Vivian Bea: As you mentioned, I am at Brooklyn practicing and we certainly see a diverse population of patients. And as everything that you have mentioned, Lisa, previously, that it's really multifactorial. There are many issues. We certainly see a large population of African-American women who do have the triple-negative breast cancer, which portends a more aggressive tumor type. And so we have to be really cognizant and thoughtful about the ways that we treat all populations of people especially in Brooklyn.

Melanie Cole: Well, thank you for that, doctors. Now, Dr. Bea, black women in particular, as you just mentioned, have faced an increased social, psychological and economic burdens and especially in this COVID time, tell us about some of the challenges they're facing and how they are really taking a toll right now on their overall health.

Dr. Vivian Bea: That's a great question, Melanie. I actually have number of patients who I talk to in depth about this in fact. COVID, as you can imagine, has brought an entirely different layer, if you will, to the barriers that we already or previously had seen. One of the additional barriers is anxiety of just coming out because of COVID. And so we encourage patients and the community to really stay on top of their health and particularly their health screening. And for breasts, that means getting a mammogram yearly at the age of 40 for most patients and sooner if there's a family history. And to really touch base with the healthcare provider to ensure that they are doing all that they need to do that's necessary despite COVID.

And so we do know that because of the barriers, social economic status as my colleague, Dr. Newman mentioned, which is lack of insurance, those barriers existed and now because of COVID, some people have, for example, lost their jobs and may not have insurance. And so we want to be thoughtful about that in Brooklyn Methodist. And so we just encourage women to continue to be proactive.

Dr. Lisa Newman: And Vivian, you stated all of that so very beautifully and eloquently. I agree with everything you said. And Melanie, as Vivian mentioned, we want women to be cognizant of their breast health, especially in the environment of having emerged from the COVID shutdown where most of our clinical services had to be diverted away with the clinics closing because we had to care for the COVID burden so suddenly, which means that all of our mammography screening programs were really shut down for several months, and we're now just getting back to that.

So in addition to encouraging women to get back on track with their mammogram screenings, which as Vivian mentioned should be every year starting at age 40, women also need to be aware now more than ever of dangerous signs of breast cancer, such as a new lump in the breast, a lump in the underarm, a bloody nipple discharge, changes in the skin or appearance of the breast, such as redness, inflammatory changes. And they need to seek medical attention promptly if any of those signs develop. Now, those signs can have benign harmless causes as well, but they need to be checked out.

And here, I also just want to give a special shout out to our own institution. Weill Cornell and NYP was really at the forefront of taking care of the metropolitan New York community during the COVID crisis when it was at its height and New York was the epicenter, but we really took charge and we're leaders in getting our community through COVID. And now we're really proud that we have been taking the lead and have figured out ways to restore normal cancer screening care and breast cancer care safely in the era of post COVID surge, but still keeping patients safe and practicing social distancing appropriately.

Melanie Cole: That's such an important point, Dr. Newman. And Dr. Bea, as Dr. Newman was just telling us a little bit about that, tell us a little bit about diversity and inclusion at Weill Cornell Medicine, specifically in the work that you're doing to help underserved populations. And have you seen any differences in the utilization of clinics and how this may have affected screening and allowed minority populations and communities to be screened faster? Do you have any stories? Tell us about your approach to care and how it's working for you really.

Dr. Vivian Bea: So, let me just say that NYP Weill Cornell has really been at the forefront as Dr. Newman has stated and really embraced diversity and inclusion. And that speaks for the leadership that speaks to just having representation. In Brooklyn, we definitely see a diverse population. And there's sort of two questions in this and I'll answer the first in how we treat those populations and is to deliver equitable care. Meaning regardless of your race or ethnicity, we are going to give you a quality care and treat you with a standard of care. And so we have a multidisciplinary team that really hold each other's feet to the fire, if you will, to ensure that all patients are treated equally with topnotch care.

Now, as it relates to the clinics with COVID, again, NYP Weill Cornell were right at the forefront. As we're forging the way, we had to make pivots to make the environment safe. And to that end, we follow all social distancing guidelines. Patients are scheduled farther apart so that there is not as much interaction.

Of course, all of our staff are wearing proper PPE. Patients are wearing face masks. And of course, hand sanitizing and frequent handwashing. Now, just to speak a little bit to the screening mammograms as Dr. Newman mentioned and as I mentioned, encouraging patients to come in and get their physical exams and see providers, what we do tell patients in the community is that it's important to feel safe and secure.

And so when you leave the house, do all of those things that we recommend, and especially in the hospital. So we want them to wear their face mask. We want them to wash their hands and to be cognizant and thoughtful in that way, because we're doing it and we've made a very safe environment in doing so.

Lisa, is there anything you would like to add to that?

Dr. Lisa Newman: I do want to emphasize what you already stated, which is that we do make sure that all of our patients receive optimal well-organized multidisciplinary care for their breast cancers. And we offer those services in a unified aligned way across all of our campuses, Brooklyn, Manhattan, and, Queens as well. But I was going to ask you, Vivian, if you wouldn't mind sharing some additional insights with us regarding the wonderful work that you've been doing in terms of partnering with the faith-based community to spread the word about breast health awareness in diverse patient populations.

Dr. Vivian Bea: So, when we talk about disparities in breast cancer, we talk about it and we knew before COVID hit, but then COVID hit, and the issues, it's there right in front of our face and we know that there are additional barriers now. And so our fear is that there's going to be a widening gap of the disparities.

And so what we have decided to do is pair up or team up with local churches in the Brooklyn area. We identified these churches. We talked to the ministers or the pastors or the leaders of the church and we really talked to them about the importance of breast health awareness, especially during the COVID era. These faith-based leaders then helped us identify women in the church who then could serve as way navigators. And so currently, those way navigators have been educated via virtual sessions where we talk about the signs and symptoms of breast cancer. We talk about when a woman should go get a mammography screening. We talk about, say, someone goes and gets a mammogram and there's an abnormal finding, what are the next steps to help guide those church women or women in the community to go through the next steps? And so those women then, as they have been educated on those factors, can then go into their church and educate women within their community. And so we have been able to improve screening mammography by doing that.

I will also say that in my NYP Weill Cornell has done an excellent job in helping support this endeavor by offering prolonged screening hours, if you will, for some locations, so that patients in Brooklyn can come after work, for example, at Brooklyn Methodist and get mammography screening because we do not want that to be a barrier. So we're excited about all that we've been able to do in the faith-based community and we will continue to do so.

Melanie Cole: What a wonderful program, Dr. Bea. Thank you for telling us about that. And as we wrap up doctors, Dr. Newman, I'd like to start with you with the first last word. Historically, the medical field has veered away. This is an uncomfortable discussion for some doctors to have. Maybe they're not used to it, and it might not even be comfortable for patients to bring this up with their doctors.

Physicians play such a critical role in addressing these public health concerns. Do you have some recommendation for your colleagues, for other providers? And you mentioned earlier, even holding their feet to the fire as it were, what would you like them to know and consider when they're treating underserved communities and certainly and especially black females right now during COVID and breast health specifically?

Dr. Lisa Newman: Well, that's a beautiful question and you stated the number of important issues. To my healthcare provider colleagues, I would simply like to emphasize what we all know, but need to make sure that we practice, which is that all of our patients deserve our very best each and every day. And that means making sure that all of our patients, regardless of appearance, regardless of any perceptions or misperceptions that the provider might have about that patient by looking at them, all of our patients deserve to be offered all the best that we have available. And we have a lot available in terms of breast cancer screening, breast health awareness, making sure that breast cancers are managed appropriately. We need to make sure that all of our patients receive every opportunity and every option available. This is especially important for African-American women because of the higher death rates from breast cancer that we see in the African-American community.

So we need to make sure that clinical trial opportunities, clinical research opportunities are equitably offered to all of our diverse patients, because we need to understand the reasons for these disparities better. And as we've been discussing throughout this conversation, screening for breast cancer and making sure the patients are aware of the danger signs of breast cancer is incredibly important.

Dr. Vivian Bea: And I would add, Lisa, that the providers, our physicians, our colleagues, have become open and I think having representation within our divisions and within our departments has certainly helped. And so as we think about diversity and inclusion, which I think was the first subject that we talked about, it's important to know that really does positively impact the care of our patients.

I also want to just note that we just put on a CME week-long symposium that addressed breast health disparities in the era of COVID-19. And really by educating our community and our providers, our healthcare providers, we can provide them with the tools necessary to really fully take care of all patients. And so it was well received and we're thankful for that.

Dr. Lisa Newman: And in addition to those educational opportunities, we do have a lot of research ongoing here addressing these disparities that we've been discussing.

Melanie Cole: As we wrap up and what a wonderful episode this was. So informative. And I could I hear the passion in both of your voices. Dr. Bea, is there anything else you'd like to let women know and also the families that love them about the importance of maintaining good breast health, about maintaining good mental health, about really just overall health at this time? And why it's so important to reach out to the specialists at Weill Cornell Medicine?

Dr. Vivian Bea: I always say that women are the backbone of our country. And it's certainly true that we are the backbone of our family units. What I tell all women is to simply check your breasts. If you notice that something is wrong or if there's something that is changed, don't hesitate to come and see us. It's better to be safe in that way.

Get your yearly mammograms. If you have to take a friend and make it a day where you celebrate the fact that you've gotten your mammogram, then do that. But by any means and all means, get the mammogram done. And we have to be mentally secure and stable. And so I often recommend meditation, eating healthy, drinking water, exercising, and really decompressing because that will help determine our overall health and allow us to be here for our families and to continue to be the backbone that we are of this nation.

Melanie Cole: Hear, hear! We cannot take care of those we love, unless we take care of ourselves. We have to put our own mask on, right, before we take care of those that we love. And it's such an important point. Thank you, ladies, so much for joining us today. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointment at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Back to Health on Apple podcasts, Spotify and Google Play Music. For more health tips, please visit WeillCornell.org and search podcasts.

Parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole. Thanks so much for listening.  

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