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.
It takes a village… the breast cancer community
Did you know that 1 in 8 women in the United States will develop breast cancer during their lifetime? As a woman, I found that to be a startling and scary statistic. As a registered nurse, it made me ask what can we as healthcare professionals do to change this situation?
October is breast cancer awareness month and the perfect time to take a broader look at breast health. Recently I had the opportunity to sit down with Dr. Amy Patel, Medical Director of the Breast Care Center at Liberty Hospital, and an amazing advocate for women’s health. Dr. Patel’s mission is to empower women and all people to take charge of their breast health.
Over the course of our discussion, we’ll address the challenges women face in managing their breast health and the role the healthcare community can play in supporting and advocating for women. As Dr. Patel mentions several times… it takes a village.
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.
Breast Health Series: Advocating for Equity in Breast Care
Part 1: It Takes a Village… the Breast Cancer Community
Kathleen: Dr. Patel, can you share your background and how you became an advocate for breast health?
Dr. Patel: My interest in radiology political advocacy and breast care inequities stem from when I was a resident, from my training years. I got involved in the American College of Radiology fairly early in my career when I was a first-year resident. From there, I got involved in the Commission for Women and Diversity and was able to establish the Women and Diversity Advisory Group for the resident and fellow section, which was a branch of the main commission. I established that group in 2015. So, when I was done with residency, I already had a passion for health inequity in general, and particularly the recruitment of women in the field and underrepresented minorities. And I think from that experience, and my interest in government relations and political advocacy, it all goes hand in hand.
Not only do I think it’s imperative to be a voice to ensure that women of color are getting the care that they deserve, but that also includes other care measures. Being sure they know when to come in for their mammogram, that it’s important to have a routine screening mammogram, or if they have a lump or an area of pain to get that evaluated. On the other hand, it’s just as important that we advocate as a breast cancer community, to ensure that they have the insurance coverage they need.
Between my interests in women and diversity, breast care inequities, and political advocacy, it has all come together and is really all come together in my career as my life’s calling.
Kathleen: I see you started your medical career in Boston, how did you get from there to practicing medicine in Missouri?
Dr. Patel: I am from a very small rural town in Missouri called Chillicothe, it’s in Northwest rural Missouri, with about 8,000 people. Where I grew up there weren’t very many people that looked like me. I started out my career after medical school at Beth Israel Deaconess in Boston. During that time, I was also faculty at Harvard, and it was wonderful. But at the same time, there were so many breast care inequities happening among all women of color back home in Missouri, in the Midwest. In Boston, there’s a specialist on every corner, but in the Midwest, there’s quite a paucity of breast imaging specialists, breast surgical specialists, and breast oncologists.
I felt a lot of guilt, and I thought that eventually, I’d come back to the Midwest to practice. I wanted to impart the knowledge and everything I had learned from not only my fellowship at Washington University in St. Louis but also in my first job at the BI. I had a really wonderful opportunity to come back and take over this breast program in the Kansas City area at Liberty Hospital in 2018 and at the same time be on faculty at the University of Missouri–Kansas City School of Medicine to continue my work.
Today we’re able to help serve a large number of patients, particularly in Northern Missouri, Southern Iowa, Kansas, Nebraska, that otherwise may not have had subspecialty care previously. And when it comes to legislation, in Missouri we’ve been able to pass two big pieces of legislation for Missouri women in 2018 and 2020. I’ve been very fortunate this far, but really my passions are how I got to where I am today.
Kathleen: Based on the legislative work you’ve done in Missouri; do you think you’ll ever try to expand those efforts to the national level?
Dr. Patel: I think so. I’m fortunate to be heavily involved in the American College of Radiology, I’m on the Government Relations Executive Committee, I’m executive leadership for the Radiology Advocacy Network, and I’m on the Breast Economics Commission. I feel like having these roles at the national level can hopefully help us. And it’s not just me, it takes a village of those who are just like me, who are just as passionate, that we can hopefully drive sweeping federal legislation.
We know this is being worked on, particularly for breast density notification. My hope is that one day we can do that for all women, so everyone has 3D mammography insurance coverage, high-risk surveillance coverage, and even diagnostic breast imaging coverage. Unfortunately, in this country, it’s still very fragmented. There are multiple states now that have 3D mammography legislation for just routine screening. But there’s still a lot of states that don’t cover high-risk patients or most certainly diagnostic breast imaging evaluation for those patients.
Another thing that people don’t think about, we passed legislation in Missouri which has been wonderful, but unless you have Missouri insurance you aren’t covered under these laws. You could be a patient that lives in Missouri but has an insurance plan that’s in another state. Let’s say you have a patient, she lives in Missouri but has Blue Cross Blue Shield based out of Tennessee, then she’s not covered under Missouri constitutional law. Sweeping federal legislation really is the key if we’re going to get all women insured in this country.
Kathleen: Looking at the bigger picture of overall health, why is breast health so important and what does that encompass?
Dr. Patel: Breast health is incredibly important because we know that breast cancer is the most common cancer in women worldwide. And if we catch breast cancer early, it’s very, very treatable. And so, that’s why we really preach early detection. It’s not only being educated to know that you need to go in for your routine surveillance but also understanding your body, what feels normal, what doesn’t feel normal. I know there are differing opinions on should you do a breast self-exam or not. Some groups don’t recommend it, some do, I am one of those in the camp of many who feel that you should be performing a breast self-exam and you should know what your breast composition feels like. This is important so that if something does pop up that feels different, you to have that evaluated.
How to Perform a Breast Self-Exam presented by City of Hope and the Pink Patch Project
That’s why I have a website that has all this information and for me preaching take charge of your breast health is so important because it’s not just about the education piece, it’s also acting on the education piece, making sure you’re getting routine surveillance, you’re understanding your body, you’re encouraging others, being an ambassador is also important as well. And shared decision-making, I think is important too. I think that we have a responsibility as a breast cancer community to talk to our patients, to see how they feel, to make decisions together, and to guide women if they feel completely lost about a breast health decision. So that’s kind of what to me, breast health encompasses. It’s multifactorial.
Kathleen: As we’ve been talking, you’ve mentioned the breast cancer community, can you expand on that?
Dr. Patel: Well, for me, it’s the breast radiologist, the breast oncologist, radiation oncology, the breast surgeon, all the advocates. We can’t do our job without wonderful organizations, such as Susan G. Komen. I’m very active in the American Cancer Society in my hometown and in Kansas City. All these cancer groups, and the Male Breast Cancer Coalition, I’m very active in that as well. We can’t do it alone; it really is a true breast cancer community.
We have a great community that works together. We may not, of course, agree on things at times, but I think it’s important that we challenge each other. This means we are pushing each other to be the very best. We figure out the best recommendations and therapies for our patients to deliver the most personalized care for them
Next week in our breast health series, I’ll talk with Dr. Patel about the challenges women face in managing and optimizing their breast health.
The next two parts of the series will cover access to care, reaching underserved communities, COVID, increasing incidence of breast cancer, breast cancer screening recommendations, and care equity for women of color.
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.