User:SRisoen/Breast cancer

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Supportive care

Breasts after double mastectomy followed by nipple-sparing reconstruction with implants

Many breast cancer therapies have side effects that can be alleviated with appropriate supportive care. Chemotherapy causes hair loss, nausea, and vomiting in nearly everyone who receives it. Antiemetic drugs can alleviate nausea and vomiting; cooling the scalp with a cold cap during chemotherapy treatments may reduce hair loss. Many complain of cognitive issues during chemotherapy treatment. These usually resolve within a few months of the end of chemotherapy treatment. Those on endocrine therapy often experience hot flashes, muscle and joint pain, and vaginal dryness/discomfort that can lead to issues having sex. Around half of women have their hot flashes alleviated by taking antidepressants; pain can be treated with physical therapy and nonsteroidal anti-inflammatory drugs; counseling and use of personal lubricants can improve sexual issues.

In women with non-metastatic breast cancer, psychological interventions such as cognitive behavioral therapy can have positive effects on outcomes such as cognitive impairment, anxiety, depression and mood disturbance, and can also improve the quality of life. Physical activity interventions, yoga and meditation may also have beneficial effects on health related quality of life, cognitive impairment, anxiety, fitness and physical activity in women with breast cancer following adjuvant therapy.

In-person and virtual peer support groups for patients and survivors of breast cancer can promote quality of life and companionship based on similar lived experiences. The potential benefits of peer support are particularly impactful for women with breast cancer facing additional unique challenges related to ethnicity and socioeconomic status. Peer support groups tailored to adolescents and young adult women can improve coping strategies against age-specific types of distress associated with breast cancer, including post-traumatic stress disorder and body image issues.

Health disparities in breast cancer

There are ethnic disparities in the mortality rates for breast cancer as well as in breast cancer treatment. Breast cancer is the most prevalent cancer affecting women of every ethnic group in the United States. Breast cancer incidence among Black women aged 45 and older is higher than that of white women in the same age group. White women aged 60–84 have higher incidence rates of breast cancer than Black women. Despite this, Black women at every age are more likely to succumb to breast cancer.

Breast cancer treatment has improved greatly over the years, but Black women are still less likely to obtain treatment compared to white women. Risk factors such as socioeconomic status, late-stage, or breast cancer at diagnosis, genetic differences in tumor subtypes, and differences in healthcare access all contribute to these disparities. Socioeconomic determinants affecting the disparity in breast cancer illness include poverty, culture, and social injustice. In Hispanic women, the incidence of breast cancer is lower than in non-Hispanic women, but is often diagnosed at a later stage than white women with larger tumors.

Black women are usually diagnosed with breast cancer at a younger age than white women. The median age of diagnosis for Black women is 59, in comparison to 62 in White women. The incidence of breast cancer in Black women has increased by 0.4% per year since 1975 and 1.5% per year among Asian/Pacific Islander women since 1992. Incidence rates were stable for non-Hispanic White, Hispanics, and Native American women. The five-year survival rate is noted to be 81% in Black women and 92% in White women. Chinese and Japanese women have the highest survival rates.

Disparities in breast cancer screenings

Low-income, immigrant, disabled, and racial and sexual minority women are less likely to undergo breast cancer screening and thus are more likely to receive late-stage diagnoses. Ensuring equitable health care, including breast cancer screenings, can positively affect these disparities.

Efforts to promote awareness about the significance of screenings, such as informational materials, are ineffective in reducing these disparities. Successful methods directly address the barriers that prevent access to screenings, such as language barriers or lack of health insurance.

Through community outreach in under-served communities, patient navigators and advocates can offer women personalized assistance with attending screening and follow-up appointments. However, the long-term benefits are unclear, primarily due to a lack of resources and staff to sustain these community-based solutions. Legislation that requires mandatory insurance coverage of language assistance and mammograms has also increased screening rates, particularly among ethnic minority communities. Innovative solutions proven effective include mobile screening vehicles, telehealth consultations, and online tools to assess potential risks and signs of breast cancer.

Disparities in breast cancer research

A diverse pool of participants in breast cancer research facilitates the investigation of the disease's unique risks and development patterns in ethnic minority populations. These populations experience better health outcomes from medical treatments designed based on research with diverse patient representation.

Within the United States, less than 3% of patients in clinical trials identify as Black, despite representing 12.7% of the national population. Hispanic and indigenous women are also significantly underrepresented in breast cancer research. Lengthy involvement in clinical trials without financial compensation discourages the participation of low-income women unable to miss work or afford traveling expenses. Monetary compensation, language interpreters, and patient navigators can increase the diversity of participants in research and clinical trials.