Breast Health Series: Advocating for Equity in Breast Care
In this 4-part series, I sit down with Dr. Amy Patel and discuss the importance of prioritizing breast health.
We explore the challenges women face in managing their breast health, potential solutions for these challenges and we look to the future and the role technology can play in optimizing breast care.
Can outreach and education solve the problem of inequity in breast care?
At the start of October, breast cancer awareness month, I had a wonderful opportunity to sit down with Dr. Amy Patel, Medical Director of the Breast Care Center at Liberty Hospital. During our discussion, she highlighted several challenges in the breast health space including, access to care, reaching underserved communities, care equity for women of color, breast cancer screening recommendations, COVID delays, and the increasing incidence of breast cancer as specific areas that need to be addressed.
The challenges we cover in Part 3 of the breast health series – access to care, reaching underserved communities and care equity for women of color – are heavily interrelated and together create a significant barrier to care. Information found on the Sisters Network and Susan G. Komen defines the disparities in breast cancer outcomes for black women and offers resources that could be helpful to women seeking care.
Each week during the month of October, I’ll share my conversation with Dr. Patel. My hope is that this information will motivate women to get their screening mammograms and inspire healthcare professionals to use their voices to raise awareness and drive change.
This week, in Part 3 of the Breast Health Series: Advocating for Equity in Breast Care, we’ll talk with Dr. Patel about solutions to address access to care, reaching underserved communities and achieving care equity for women of color. You’ll also find links to resources from Susan G Komen.
Breast Health Series: Advocating for Equity in Breast Care
Part 3: Can outreach and education solve the problem of inequity in breast care?
Kathleen: As we continue our discussion around the challenges women face in managing their breast health, I’m going to combine three issues that you identified as they seem to be interrelated – access to care, reaching underserved communities, and care equity for women of color.
Can you talk to me about these challenges and potential solutions you think could help address these problems?
Dr. Patel: We touched on access to care and insurance coverage is such a huge piece of it. Women who right off the bat don’t have insurance coverage are less likely to go seek avenues to potentially be covered and get care. So that’s one piece, reaching our underrepresented minorities, reaching those at-risk groups is important. We know that Caucasian women are more likely to be diagnosed with breast cancer, but black women are 40% more likely to die. It’s important for us to get out there and talk to these communities, but it can be difficult because there’s historically a lack of trust.
Building trust with these communities is important and it takes time and persistent efforts. I hear all the time in clinical practice, we’re strapped very thin, I don’t have time to go out in the community plus take on my clinical workload. In my opinion, if we are not the ones stepping up, then we’re just going to continue to have disparities that continue to deepen and deepen.
Where I think we start in terms of access to care and reaching underserved communities is by educating people in positions of power that can influence and make a change, make a difference. So, a lot of this political advocacy, economics, health policy, we’re not really taught this stuff in medical school, or in residency. Education during medical school is an important starting point.
Now, particularly in radiology residency, we are required to fulfill what’s called health care economic milestones to meet our ACGME (Accreditation Council for Graduate Medical Education) requirements. But that is a very new concept that has just happened since I was in training. Any radiologist before my time didn’t even have that as a requirement. So, I think there’s still a tremendous lack of education amongst physicians on these topics in this country.
We need to get the physicians, those in positions of leadership at hospital systems and major organizations, educated on these topics. This needs to include our elected officials, which is incredibly important. Only 6% of congress has a healthcare background. The rest, 94%, do not. It’s important for these people who are making decisions, who are in positions of power to truly be educated on the subject so that we can do the right thing and we can get the proper insurance coverage for our patients, and we can essentially save the most lives.
Kathleen: Let’s shift the discussion to reaching underserved communities and potential solutions for reaching these women.
Dr. Patel: I don’t think there’s just one solution, I think, again, there are multiple layers to this. I think that education and community outreach is really important. I think building trust is really important. Pre-pandemic, I was going into predominantly black churches in Kansas City and talking about breast health in front of a congregation on a Sunday morning. It was so wonderful that they allowed me to do that, it created relationships. It’s going to take a boots on the ground approach to build trust and to unite with coalitions that focus on underrepresented minorities, both are really important.
We are fortunate now across Kansas City, we have a breast health equity task force. It is a new task force comprised of patients, patient stakeholders, people with a clinical background, such as myself, together we’re trying to figure out ways to combat any sort of inequities. It’s a tall order and we’ve found it obviously very, very challenging. A lot of our strategy is dividing and conquering, reaching out to stakeholders in key geographical locations that have the most influence to reach these patients.
Then of course we need to have the resources in place for those who then reach out to us. That means in my practice nurse navigation is a very, very important thing. The nurse navigators really are the backbones of breast programs. They are able to impart so much education and guidance for patients, regardless of color. They really are a wonderful resource.
Additional resources are also needed. At my breast center, we have a women’s health fund through our foundation. If there are patients who aren’t able to afford a mammogram or a biopsy or something like that, we get them hooked up with our nurse navigators, with our finance firm, and social workers, and make sure that they’re able to be taken care of.
I think it takes a multifaceted approach, and again, stressing community outreach and working together with multiple stakeholders are imperative components if we’re going to make any headway in this arena.
Kathleen: Let’s talk about achieving care equity for women of color.
Dr. Patel: Here I think the outreach component is so important. For example, today we know black women tend to have the more biologically aggressive cancers or triple-negative cancers. We know that there are some ethnic groups that are more predisposed than others to certain kinds of cancers. This information becomes an important part of the outreach we do. We need to be sure that we’re really, really looking at women of color data so that we can come together and figure out what targeted therapies might be needed and what we need to do from, again, an educational standpoint with community outreach.
I think, again, it takes a village, there’s a lot of layers to this, it’s going to take a lot of time. I think that the sooner we can all work together and try to combat this, the better it will be. There are a lot of people across the country that are working hard to drive care equity.
Racial and Ethnic Differences in Breast Cancer
Breast cancer is the most common cancer among women. Yet, the rates of getting and dying from breast cancer differ by race and ethnicity.
What do you think are solutions to address inequities in breast care? Does your facility have an outreach program in place? We’d love to hear your thoughts and recommendations, please drop us a note in the comment section below.
Next week is the final segment in our breast health series. We’ll talk with Dr. Patel about the future of breast care and technologies that could play a role in early diagnosis and help address the challenges we’ve been discussing.
Join us here next week, there’s lots more to discuss!
This series is based on an interview with Dr. Amy Patel and has been lightly edited for written clarity.