Research has fueled advances in early detection, prevention and treatments that have had significant impact on breast cancer outcomes. Many women are living longer after diagnosis—there are nearly 3 million breast cancer survivors in the U.S. today. Doctors, patients and researchers agree, however, that many challenges remain in resolving breast cancer.
One major challenge is the disparities that persist in certain populations and how to ameliorate them. Disparities occur across the spectrum of cancer care, from prevention and early detection to treatment and end-of-life care. We also know that discrepancies in breast cancer outcomes are complex and include socioeconomic, cultural, geographic and racial/ethnic factors. Solutions will require transdisciplinary and multilevel approaches to produce effective interventions and policy changes.
BCRF’s commitment to ending breast cancer includes supporting research to:
BCRF is also dedicated to fostering collaboration in the research community to identify opportunities and develop strategies that will have the most impact on prevention and treatment of breast cancer anywhere health inequities exist.
“Despite remarkable scientific progress, there are many areas where different groups of patients still lag in outcomes,” said Dr. Clifford Hudis, Chairman of BCRF’s Scientific Advisory Board. “Closing the gaps in access to care and in our understanding of where and how the underlying biology may vary across different groups of patients is critical to our overall mission. “
Last October, BCRF sponsored a two-day meeting to enhance our efforts to reduce breast cancer disparities Spearheaded by Scientific Advisory Board member Dr. Patricia Ganz with the help of a coordinating committee that included Drs. Peter Greenwald, Arti Hurria, Dawn Hershman and Electra Paskett, the meeting convened experts in disparities and health outcomes research, epidemiology, psychosocial and behavioral sciences, research oncologists and representatives from the patient community.
The purpose of the meeting was to identify central areas in disparities research where innovative strategies can be employed to close the gaps in breast cancer outcomes. Dr. Ganz and the coordinating committee invited experts to provide an overview of current challenges and share success stories in implementing interventions in their communities.
Carol Ferrans PhD, RN (University of Chicago) kicked off the meeting by sharing the successes and challenges of implementing a community-led effort to address breast cancer disparities in Chicago. Key to the program’s success was fostering community support, which in turn drove necessary policy changes. Roshan Bastani, PhD (University of California, Los Angeles) continued that theme, emphasizing the need to focus on community-based participatory models involving multidisciplinary teams.
Nina Bickell, MD, MPH (Mount Sinai, Center for Health Equity & Community-Engaged Research) spoke about access to care and insurance as predominant drivers of disparities in poor urban communities. She emphasized the need for information-sharing among clinical care team members, tracking follow-up and creating a patient-centered culture to improve clinical care in low-resource settings.
Rural women with breast cancer face barriers at all points of the cancer care continuum, from screening to survivorship and end-of-life care. They are less likely to receive standard of care and adequate psychosocial support and are more likely to suffer from depression and other quality of life issues. For this population, Dr. Electra Paskett emphasized the need for tailored interventions to improve access to screening and prevention counseling along with the patient’s experience with treatment, follow-up and survivorship.
Latina Americans experience disparities in breast cancer outcomes compared to other Americans, regardless of economic status. Dr. Annette Stanton emphasized the psychosocial needs and their impact on long-term outcome and adherence to preventive therapy after a diagnosis, and noted that depression is a predictive factor. Currently little is known about the psychosocial impact of breast cancer in Latinas (as well as in many other ethnic groups, with the possible exception of African Americans). Citing her own work with Latinas, Dr. Stanton noted that women who identified strongly with their Latin culture but were fluent in English were less likely to experience depression.
Older patients have poorer outcomes than younger patients for a variety of reasons, but this group is often excluded from clinical trials because of health conditions that can co-exist with cancer in the elderly. Dr. Hurria presented a model for clinical trials to test cancer drugs in older patients to better understand their side effects and capture the characteristics of this population.
Blase Polite, MD (University of Chicago) shared findings from a recent think-tank on disparities in cancer care sponsored by the American Society of Clinical Oncology, American Association for Cancer Research, American Cancer Society and National Cancer Institute. The meeting’s goal was to identify gaps in disparities research and cancer care and develop strategies to address priority areas. The discussions will form the basis of recommendations and a coordinated statement from the leading funders of cancer research in the U.S.
Following the presentations, the workshop participants broke into working groups to identify priority areas where innovative strategies could have the most impact on reducing breast cancer disparities. The group plans to publish a discussion paper in the hopes of stimulating new ideas and collaborations to address the most pressing needs, so plans for resolving disparities can be put into place.
“BCRF provided an important opportunity for thought leaders in breast cancer and disparities research to come together and discuss these issues,” Ganz said. “Having a better understanding of the landscape is an important first step towards identifying new research opportunities that can address inequities in breast cancer diagnosis, treatment, prevention and survivorship.”
Other participants in the workshop included: Clifford Hudis; Graham Colditz; Edith Perez; Sandra Swain; Mary Beth Terry; Beverly Canin (patient advocate); Elise Cook, MD, MS (University of Texas MD Anderson Cancer Center); Karen Freund, MD, MPH (Tufts University Medical Center); Sarah Gehlert, PhD, MA, MSW (Washington University, St. Louis); Elena Martinez, PhD (University of California, San Diego); Jewel Mullen, MD, MPH, MPA (Commissioner, Connecticut Department of Public Health); Julia Rowland, PhD (National Cancer Institute, Office of Cancer Survivorship); Patty Spears (patient advocate), and Beti Thompson, PhD (Fred Hutchinson Cancer Research Center).
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