Breast Cancer Disparities Through the Lens of the COVID-19 Pandemic

Purpose of Review

The emergency medicine and critical care needs of the COVID-19 pandemic forced a sudden and dramatic disruption of cancer screening and treatment programs in the USA during the winter and spring of 2020. This review commentary addresses the impact of the pandemic on racial/ethnic minorities such as African Americans and Hispanic-Latina Americans, with a focus on factors related to breast cancer.

Recent Findings

African Americans and Hispanic-Latina Americans experienced disproportionately higher morbidity and mortality from COVID-19; many of the same socioeconomic and tumor biology/genetic factors that explain breast cancer disparities are likely to account for COVID-19 outcome disparities.

Summary

The breast cancer clinical and research community should partner with public health experts to ensure participation of diverse patients in COVID-19 treatment trials and vaccine programs and to overcome COVID-19-related breast health management delays that are likely to have been magnified among African Americans and Hispanic-Latina Americans.

Radiation-Induced Skin Changes after Postmastectomy Radiation Therapy: A Pilot Study on Indicators for Timing of Delayed Breast Reconstruction

Background Delayed autologous breast reconstruction is commonly recommended in patients requiring postmastectomy radiation. This study examines gross and histologic changes in the breast skin of patients who have undergone postmastectomy radiation to help determine when radiation-induced skin changes begin to stabilize.

Methods A prospective pilot study was conducted on eight patients with invasive breast cancer who required mastectomy and radiotherapy. At the time of mastectomy and 2, 4, 6, 8, and 12 months after completion of radiotherapy, a punch biopsy was taken from the radiated mastectomy skin of each patient. Serial standardized photographs were taken before and after radiotherapy to evaluate the degree of hyperpigmentation and graded by three blinded plastic surgeons. Skin biopsies were processed for histologic assessment of inflammation, elastin organization, and vascularity.

Results Grading of patient photographs revealed an increase in hyperpigmentation after radiotherapy compared with baseline with a gradual improvement over time. SMAD3 immunostaining demonstrated a trend toward an increase in inflammation over 12 months. The elastin distribution within samples showed an increase in fiber disorganization, thickening, and clumping, with no improvement throughout the study period. The average number of vessels per high powered field decreased steadily through the duration of the study.

Conclusion Histologic changes in dermal inflammation, elastin organization, and vascularity do not appear to correspond with the gradual improvement of hyperpigmentation, resulting from postmastectomy radiation. These histologic changes persist beyond the 12 month observation period and will require clinical correlation to determine the potential impact on postoperative outcomes.

The aging midfacial skeleton: implications for rejuvenation and reconstruction using implants

Traditional theories on facial aging and methods for rejuvenation focus primarily on soft tissues with ptosis as the major mechanism responsible for senescent changes. Anatomic studies demonstrate that there are also many changes to the craniofacial skeleton as patients age. Midface skeletal augmentation, using implants made of porous polyethylene, is a simple and effective method to reverse age-related changes of the facial skeleton in patients with intact occlusion. Skeletal implants correct concave morphology by increasing projection and provide a means to resuspend cheek soft tissues that have descended off a deficient bony platform. Beyond rejuvenation, skeletal implants can be used to restore facial proportions in patients with midface deficiency secondary to trauma, congenital deformity, or other pathologic states.