Clinico-pathologic disparities of breast cancer in Hispanic/Latina women

mHealth Interventions to Improve the Breast Cancer Continuum of Care from Prevention to Survivorship of Hispanic Women: A Scoping Review

BACKGROUND

Breast cancer is the leading cause of cancer mortality in Hispanic women in the USA. Current interventions to improve breast cancer care include the use of mHealth, but its application in Hispanic women is limited. This scoping review aimed to describe the extent of research literature on the use of mHealth throughout the breast cancer care continuum (prevention, early detection, and treatment) in Hispanic women.

METHODS

A scoping review guided by the Arksey and O'Malley methodological framework and the Joanna Briggs Institute scoping review reporting protocol. Literature search of peer-reviewed research articles from 2012 to 2022 in PubMed, Scopus, and CINAHL® was conducted in March and June 2022.

RESULTS

Of the 10 articles selected, seven included Hispanic breast cancer survivors and three included Hispanic women at risk for developing breast cancer. Seven articles involved mobile applications and three articles used text messaging and/or cell phone voicemail. Overall, the use of mHealth for breast cancer care in Hispanics was favorable but generalizability was limited given the type of design and small samples. All interventions were tailored to Hispanic culture.

CONCLUSION

Scarcity of research on mHealth in Hispanic breast cancer care highlights healthcare disparities in this population. Evidence from this review suggests the use of mHealth to be beneficial to improving breast cancer care in Hispanics, but more research is needed involving randomized clinical trials and larger samples.

Racial and Ethnic Inequality in Survival Outcomes of Women With Triple Negative Breast Cancer

Purpose

Triple-negative breast cancer (TNBC) is the most lethal group of breast cancers. Socioeconomic factors may contribute to differences in survival rates. This study aims to identify racial/ethnic disparities in five-year survival rates among women affected by TNBC in the United States.

Methods

This retrospective study analyzed data from the 2010-2016 Surveillance, Epidemiology, and End Results Program database. Patients with a primary malignancy of triple-negative breast cancer were included in this study. Cancer-specific survival was measured at five years post-diagnosis. Cox regression models were used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI).

Results

From 2010-2016, there were 26,963 women with a primary diagnosis of TNBC. After adjustment for age, insurance, marital status, stage, and surgery type, Hispanic women had the highest hazard of death when compared to White women (adjusted (adj) HR, 1.14, p<0.001). Further, non-Hispanic Black women also had a lower survival probability when compared to White women (adj HR, 1.06, p=0.002).

Conclusion

This study reveals that Hispanic women had the highest hazard of death when compared to White women. As TNBC is the most fatal breast cancer, future studies should investigate socioeconomic factors that may worsen prognosis of this disease.

Granulomatous mastitis: An underdiagnosed inflammatory disease afflicting minority women

Granulomatous mastitis (GM) is an underdiagnosed and understudied benign inflammatory disease of the breast whose accurate diagnosis is confounded by mimicry of other breast pathologies (infectious mastitis and abscess, malignancy) and limited clinician knowledge of the disease. GM disproportionately affects minority women, furthering health disparities for a demographic already disadvantaged in the care of breast diseases. The first step in diagnosis is ultrasound followed by core needle biopsy yielding granulomatous inflammation. To far lesser degree, mammography, and MRI may play a role in narrowing the differential. A high index of clinical suspicion and multidisciplinary approach is required. The presence of Corynebacterium kroppensteddti may indicate one subtype of granulomatous mastitis called cystic neutrophilic granulomatous mastitis; disease stratification, and individualized therapy are on the horizon.

"I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema

Objective:

Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema.

Methods:

Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women’s experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology.

Results:

The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices.

Conclusions:

Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.

The hispanic landscape of triple negative breast cancer

Triple-negative breast cancer (TNBC) is a heterogeneous and complex disease characterized by the absence of immunohistochemical expression of estrogen receptor, progesterone receptor and HER2. These breast tumors present an aggressive biology and offer few opportunities to be treated with targeted therapy resulting in bad disease outcomes. The epidemiology of TNBC is intriguing where the understanding of its biology has progressed quickly. One of the peculiarities of this type of cancer is a high prevalence in Afrodescendants and Hispanic patients compared to Caucasian women. In this review we describe some features of TNBC, focusing in the Hispanic population, such as epidemiological, clinicopathological features and molecular features and the correlation between TNBC prevalence and the human development index.

Supportive health education reduces health care utilization and costs in Latinas with breast cancer and their caregivers

PURPOSE

To compare costs and relative cost savings from reductions in unscheduled health services use for two 8-week psychosocial interventions (telephone interpersonal counseling [TIPC], supportive health education [SHE]) delivered by telephone to Latinas with breast cancer and their informal caregivers. Cost information is required before adopting supportive care interventions as part of routine care. There is limited information on costs of producing supportive care interventions or their impact on service use.

METHODS

Latinas and their caregivers were randomized to either TIPC or SHE. At baseline and month 4, hospitalizations and urgent care and emergency department (ED) visits in the previous month were recorded. These were compared by trial arm for 181 survivors and 169 caregivers using logistic regression, adjusting for age and health services use at baseline.

RESULTS

Total cost per 100 survivors was $28,695 for SHE and $27,399 for TIPC. Urgent care and ED visits were reduced for survivors in SHE versus TIPC (odds ratio (OR) = 0.31, 95% confidence interval (CI) [0.12, 0.88], p = .03). For hospitalizations, OR for SHE versus TIPC was 0.59, 95% CI [0.26, 1.37], p = .07. There were no differences between trial arms for caregiver health services use. Cost savings for SHE versus TIPC from reductions in health services use per 100 survivors ranged from $800 for urgent care to $17,000 for ED visits and $13,000 for hospitalizations.

CONCLUSIONS

Based on this evidence, SHE can be a cost-saving supportive care solution that benefits not only survivors and caregivers, but also oncology practices reimbursed through episodes of care.

Psychological Distress and Social Support Availability in Different Family Caregivers of Latinas With Breast Cancer

Introduction: Latinas with breast cancer draw on a diverse range of family members for informal care. Latin cultures typically prescribe high levels of support and care for an ill family member that leave caregivers vulnerable to compromised well-being. Method: In this cross-sectional survey study, 258 family caregivers of Latinas with breast cancer completed reports of psychological distress, availability of social support, and acculturation. Results: Mothers who provide care to a daughter with breast cancer experience higher levels of psychological distress and report lower availability of informational support than most other types of family caregivers. Mothers’ lower levels of acculturation may at least partially explain these reductions in well-being. Discussion: This study highlights the diverse range of family and fictive kin who participate in family caregiving for Latina breast cancer survivors. Spousal caregivers may not represent a unique population, whereas mothers as caregivers are indeed distinct for their higher distress levels.

Epithelial-Mesenchymal Transition Markers in Breast Cancer and Pathological Responseafter Neoadjuvant Chemotherapy

The association between pathologic complete response (pCR) following to neoadjuvant chemotherapy (NAC) and the improved survival in breast cancer has been previously reported. The aim of this study was is to explore the expression of several biomarkers described during epithelial-mesenchymal transition (EMT) and the achievement of pCR in different molecular subtypes of breast cancer. We identified archived pathology tissue from patients with breast cancer who received NAC during the year 2014. We performed immunohistochemical analysis of vimentin, nuclear factor κB (NF-κB), epidermal growth factor receptor (EGFR), E-cadherin, estrogen receptor (ER), progesterone receptor, and Her2neu and studied the association between the expression of these markers and pCR. A Fisher exact test for categorical cofactors, an unpaired t test and a nonparametric Wilcoxon test for continuous cofactors were used. The results showed a significant expression of vimentin in triple-negative breast cancer (TNBC; P = .023). An inverse correlation between vimentin and the ER expression (P = .032) was observed. No significant association was noted for vimentin, NF-κB, EGFR, and E-cadherin was associated with pCR. This study suggests that the evaluated EMT related biomarkers are not associated with pCR after NAC chemotherapy in an unselected breast cancer population. Vimentin and NF-κB expressions were associated with TNBC and could be further explored as potential therapeutic targets in this subgroup. A prevalence of vimentin and NF-κB among Hispanic patients with breast cancer warrants further investigation as a possibly contributing to the prevalence of TNBC and adverse prognosis in this population.