Racial and regional disparities in deaths in breast cancer

Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer

PURPOSE

Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer.

METHODS

We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis.

RESULTS

Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust.

CONCLUSIONS

Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence.

IMPLICATIONS FOR CANCER SURVIVORS

Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.

Racial and Ethnic Disparities in Screening Mammography During COVID-19 in the Upper Midwest

OBJECTIVE

Studies conducted prior to COVID-19 suggested that racial and ethnic disparities in mammographic screening have reduced over time. COVID-19 has had devastating effects on racial and ethnic minority populations, resulting in delays in preventive screening. Our purpose was to determine if racial and ethnic minority groups were less likely to receive mammographic screening during the COVID-19 pandemic.

METHODS

Retrospective cross-sectional study was conducted in a multisite academic medical center in the Upper Midwest to evaluate screening disparities during the COVID-19 pandemic. Participants included 50- to 74-year-old female individuals (June 2021 to May 2022). Additional control group was included for pre-COVID-19 case-control comparison (June 2018 to May 2019). Unadjusted and adjusted logistic regression analyses estimated the association between screening and race and ethnicity including interaction terms to assess temporal interactions associated with COVID-19. Study was deemed exempt from institutional review board review.

RESULTS

In all, 37,509 eligible female patients were included. Of them, 73.8% of eligible patients received a mammogram within the last 2 years (White 74.7%, Black 57.6%, Asian 67.0%, American Indian 60.1%, Hispanic 64.2%). In our adjusted analyses, Black (P < .001), Asian (P = .003), and American Indian patients (P = .001) were less likely to receive screening. Hispanic patients were comparably likely to receive screening (P = .338). Non-English-preferred languages, uninsured or Medicaid, and living in rural areas were associated with decreased screening (P < .001). In all, 36,768 eligible female patients were included for pre-COVID-19 comparison. Compared with the pre-COVID-19 time period, COVID-19 was associated with increased screening disparities (P < .001) for Black and Hispanic women (P < .001).

CONCLUSION

The COVID-19 pandemic was associated with increased racial and ethnic screening disparities. Targeted outreach efforts are required to ensure equitable access to mammographic screening for medically underserved patient populations.