Submission
| Title: |
Breast Cancer Disparities and the Impact of Geography |
| Co-Authors: |
Obeng-Gyasi, Barnabas, Indiana University School of Medicine; Samilia Obeng-Gyasi, MD, MPH; Willi Tarver, DrPH, MLIS, Division of Surgical Oncology, Department of Surgery, The Ohio State University; Division of Cancer Prevention & Control, Department of Internal Medicine, College of Medicine, The Ohio State University |
Abstract
Background/Significance/Rationale: National discussions of health disparities and health equity have placed a spotlight on social determinants of health (SDH). In the United States, place of residence has emerged as a powerful SDH, with some scholars suggesting that zip code is more significant for health outcomes than genetic code. This assertion is rooted in the effects of governmental policy, societal values, and cultural norms on the creation of neighborhoods and its subsequent implications for health and health outcomes. For patients with breast cancer in particular, current studies suggest area of residence is a determinant of breast cancer stage of diagnosis, treatment, and mortality. The objective of this article was to provide a contemporary overview of the impact of place of residence on screening, stage, treatment, and mortality among patients with breast cancer.
Methods: 62 sources of recently published literature was compiled and evaluated
Sources focused on Neighborhood and Rural-Urban status. Each was examined on the variables of Breast Cancer Screening, Treatment, and Mortality
Results/Findings: Hospitals should:
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Routinely collect SDH as part of clinic workflow to identify barriers faced by patients in rural or high deprivation neighborhoods.
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Incorporate social work or patient navigation to help mitigate barriers.
Conclusions/Discussion: Area of residence has significant implications for breast cancer screening, stage of diagnosis, treatment, and mortality. However, there are significant gaps in the literature on the impact of neighborhood on the receipt or completion of systemic therapies. Moreover, additional research needs to be conducted on how place influences emerging changes in surgical management such as implementation of axillary surgery de-escalation, elimination of low-value surgical procedures, and the use of oncoplastic reconstruction. Health systems need to incorporate population health into their healthcare delivery paradigms to help identify and address the effects of place on breast cancer outcomes.
Translational/Human Health Impact: Incorporating population health into health care paradigms plays a vital role in ensuring hospital systems all around the country can work towards the common goal of health equity. This research shows that if we take a wholistic approach by including neighborhood to mitigate barriers to patient care, several aspects of a patient’s hospital care and their survivorship all can improve.
