Poster Spotlight Session 18: Disparate Care Calls for Desperate Measures: Understanding Gaps in Quality of Care and Opportunities to Improve It
Friday, December 8 • 7:00 a.m. – 8:00 a.m. • Stars at Night Ballroom 1-2
Presentation: The Association between Food Deserts, Food Swamps, and Postmenopausal Breast Cancer Mortality in the United States
Malcolm Bevel, PhD, MSPH
Augusta University,
Augusta, Georgia
What is your presentation about?
My presentation is about the association between food deserts, swamps, and postmenopausal breast cancer among U.S. counties or county equivalents over the last 10 years. We know a lot about food deserts in general, but “food swamps” is a relatively new term that is likely the more accurate description of the food environment in the U.S. Food deserts are areas with no grocery store in a 1-mile radius; food swamps lack grocery stores and have pro-inflammatory food options (i.e. fast-food, convenience stores, liquor stores). Studies on the association between food deserts, swamps, and postmenopausal breast cancer are rare, which is why we decided to examine this potential relationship. After adjusting for age, percentage of NH-Blacks per county, and poverty rate, we found 42% increased odds of having high postmenopausal breast cancer mortality rates among U.S. counties/county equivalents with high food swamp scores.
What makes this topic important in 2023?
It is important in 2023 as we hypothesize that, like obesity, food swamps are another epidemic in this country that we must combat in order for people to live healthier lives. Food insecurity in general is already too prevalent for my taste, and now we’re seeing that there are less healthy food options and more unhealthy food options especially in underserved communities. We hypothesize that this could be due to systemic issues (e.g. gentrification, redlining) and there are unique methods we can utilize to counteract any systemic issues surrounding these built food environments.
How did you get involved in this particular area of breast cancer research, care, or advocacy?
I have breast cancer survivors in my family, and racial disparities regarding breast cancer continue to persist. Also, a lot of my family members (much less myself) have lived in poorer food environments for most of their respective lives. While biology plays a significant role in cancer outcomes, I’ve always been interested in the social determinants of health that significantly contribute to obesity, obesity-related cancers like breast cancer, and the disparities associated with them. We have a grand opportunity to reduce these disparities and we cannot overlook the impact that the social and built environment has on breast cancer.
Presentation: Stage Advancement and The Rate of Growth Associated with Preoperative Delay in Patients Having Breast Cancer
Richard J. Bleicher, MD, FACS
Fox Chase Cancer Center,
Philadelphia, Pennsylvania
What is your presentation about?
We know that delays in treatment cause poorer outcomes. We previously published the definitive study demonstrating this (Bleicher, JAMA Oncol 2016). But while we assume the reason for the decline in outcomes associated with the delay is upstaging and spread of disease, there is little data on the risk of upstaging associated with those delays. Moreover, patients become concerned that their waiting times before treatment may result in tumor growth and spread to lymph nodes if the tumor hasn’t already. This study assessed the likelihood of primary tumor upstaging, based upon the stage they presented at, as well as the rates of tumor growth that occur in the patient during that delay. In addition to the rate of growth of the primary, we assessed how longer times to surgery increase the risk for spread to lymph nodes especially if the patient’s nodal assessment starts out clinically negative.
What makes this topic important in 2023?
Although delays in breast cancer treatment have been deemed a danger ever since Halsted published his first series over a century ago in 1907, the issue of delays in treatment has become even more pertinent now, as resources become more scarce, and the incidence of breast cancer increases with each passing year. As the workup becomes more complex, patients transfer between providers, and logistical challenges mount, time to surgery has become a ‘timely’ topic and one which is pertinent to every provider, every patient, and every institution. With disparities at the forefront of people’s attention, it also remains an area that should be top-of-mind when trying to ensure that socioeconomically-disadvantaged groups can get good breast cancer care.
How did you get involved in this particular area of breast cancer research, care, or advocacy?
When I started doing research in timeliness and delays back in 2010, there was very little published literature out there; only surveys by the Advisory Board company as to what people were reporting their timeliness of care to be. But frustratingly, nearly every single patient walked into my office wanting to know how long was “too long” to wait for surgery or treatment. And yet there was no good comprehensive or national data at that time. It was at that point that my career research focus shifted to figure out how timeliness of care affected outcomes and other factors related to breast cancer. So among other studies, we have determined how the workup (that is needed on patients) contributed itself to delays (Bleicher, J Clin Oncol 2012). We determined how survival in DCIS (Ward, Ann Surg Oncol 2019) and disease specific survival and overall survival for invasive disease have been affected (Bleicher, JAMA Oncol 2016), the (lack of) differences in how delays affect outcomes by phenotype (Mateo, Ann Surg Oncol 2019), and even how multidisciplinary care, which is desirable, can contribute to delays (Churilla, Breast Cancer Res and Treat 2016) among others. As Quality Chair of the NAPBC for the past several years, I have also delved into this topic from a quality standpoint, and been involved to advocate for and implement a CoC/NAPBC quality measure on time to surgery which was rolled out in 2022, and radiation quality measure which is being programmed by the CoC for RCRS now (stemming from this data on delays and radiotherapy: Bleicher, Ann Surg Oncol 2021). We also are finalizing a Medical Oncology timeliness measure in a similar vein. Improving timeliness improves patient outcomes, and yet doesn’t have the costs or side effects of some other components of care which have similar improvement benefits. So to me that’s, as they say, a ‘no-brainer.’
Presentation: Racial Disparities in Breast Cancer and Effect of Obesity: MammaPrint, BluePrint and Whole Transcriptome Analyses of Tumors in Latin American Patients in FLEX Trial
Marcela Mazo-Canola, MD
Mays Cancer Center,
San Antonio, Texas
What is your presentation about?
This study looks into the transcriptomic profiles of breast tumors from Latin and Caucasian patients enrolled in FLEX registry as well as their metabolic and genomic factors to enhance understanding of factors contributing to aggressive tumor biology in Latin patients.
We also compared transcriptome of tumors from Luminal B and obese LA and Black patients to assess population differences in high-risk groups.
What makes this topic important in 2023?
This study highlights potential genomic differences in Latin patients when compared to clinically matched white and Black subjects, suggesting these differences may have a role in the aggressive tumor biology we see in Latin patients.
How did you get involved in this particular area of breast cancer research, care, or advocacy?
Personal interest in health / racial disparities that affect the Latin population.