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Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity
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Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 15113

Special Issue Editors

Prof. Dr. Electra Diane Paskett

E-Mail Website
Guest Editor
Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University, Columbus, OH, USA
Interests: breast, cervical and colorectal cancer prevention and screening; follow-up of abnormal test results; treatment access; survivorship issues
Prof. Dr. Beti Thompson

E-Mail Website
Guest Editor
Public Health Sciences, Fred Hutchinson Cancer Research Center; Health Services Department, University of Washington Seattle, WA, USA
Interests: health disparities; underserved Latinas; breast, cervical, and colorectal cancer prevention and screening; access to health care; breast cancer in low-resource countries; BRCA gene mutations

Special Issue Information

Dear Colleagues,

Breast cancer is now the most common cancer among women worldwide, accounting for 12% of all new annual cases (WHO, 2021). The burden of breast cancer risk, incidence, and mortality, however, is not distributed equally among all populations. Certain population groups such as Black women, Latinas, Indigenous women, women who live in rural areas, and other groups who experience health disparities are more likely to die from breast cancer than other women. Reversing this trend requires attention to interventions promoting prevention and early detection strategies among disparate groups, as cancers prevented or detected early and treated appropriately dramatically increase the chances for survival. Many innovative and efficacious intervention strategies have been designed, tested, and even implemented to increase the uptake of prevention and early detection efforts to reduce disparities in breast cancer outcomes among populations who suffer from them. Such work is important to guide the path to equity in breast cancer outcomes. Hence, we seek to establish a compendium of successful and efficacious breast cancer prevention or early detection intervention and implementation projects among populations experiencing disparities in breast cancer outcomes.

The aim of this Special Issue of Cancers is to present studies that have tested successful interventions to increase the uptake of prevention and early detection strategies among populations that suffer from breast cancer disparities. Observational studies do not meet the requirements of this Special Issue.

Research areas may include (but are not limited to) the following related to breast cancer: interventions testing risk identification among women experiencing disparities; increasing uptake of genetic/counseling/testing; promoting the use of chemoprevention; diet/exercise/obesity interventions; screening/early detection interventions, such as testing new modalities and promoting mammography/MRI screening; assuring follow-up of abnormal screening test results.

In this Special Issue, original research articles and reviews are welcome.

We look forward to receiving your contributions.

Prof. Dr. Electra Diane Paskett
Prof. Dr. Beti Thompson
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast cancer
  • mammography
  • breast cancer disparities
  • genetic testing
  • genetic counseling
  • chemoprevention
  • obesity
  • diet
  • exercise
  • abnormal follow-up

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Published Papers (6 papers)

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Research

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15 pages, 1787 KiB  
Article
Motivational Interviewing Counseling to Increase Endocrine Therapy Adherence in Diverse Patients
by Stephanie B. Wheeler, Jennifer Spencer, Sarah W. Drier, Niasha Fray and Katherine E. Reeder-Hayes
Cancers 2023, 15(7), 1973; https://doi.org/10.3390/cancers15071973 - 25 Mar 2023
Cited by 2 | Viewed by 1816
Abstract
Background: Oral endocrine therapy (ET) is an inexpensive and effective therapy for hormone receptor-positive (HR+) breast cancer that prevents recurrence but relies upon long-term adherence for up to ten years. More than 80% of breast cancer patients have an HR+ phenotype and are [...] Read more.
Background: Oral endocrine therapy (ET) is an inexpensive and effective therapy for hormone receptor-positive (HR+) breast cancer that prevents recurrence but relies upon long-term adherence for up to ten years. More than 80% of breast cancer patients have an HR+ phenotype and are candidates for ET, but approximately half discontinue or become non-adherent by five years. ET underuse is more prevalent in Black and young (<50 yrs) women, which may contribute to outcome disparities in these groups. The objective of this study was to evaluate the feasibility, acceptability, and utility of a patient-centered counseling intervention to enhance ET adherence, with a focus on the needs of Black and younger women. Methods: We conducted a single-arm pilot study of a twelve-month motivational interviewing (MI) intervention consisting of five MI counseling sessions, an interactive workbook, a resource guide, and an educational video developed and revised with iterative patient and clinician input. The eligible participants were >18 years old, English speaking, and with stage I–III HR+ breast cancer. Participants were recruited across a large academic medical center and four community sites. Feasibility and acceptability were assessed by measures of participant recruitment, retention, session participation, and patient-reported satisfaction. ET adherence at 12 months was assessed by self-report and medication event monitoring system (MEMS) caps using a continuous measure of the proportion of days covered (PDC) as well as a dichotomous measure of the optimal adherence, defined as >80% PDC. Results: Forty-two women initiated the intervention, of whom thirty-five participants (83%) completed outcome assessments at 12 months, including thirteen Black and twenty-two non-Black participants. The average participant age was 54.8 years (range: 25–73). Overall, 97% completed at least three MI sessions and 83% completed at least four sessions. Participant retention and satisfaction were high, particularly among Black women. Self-reported adherence at 12 months was 88% overall (100% in Black women and 81% in non-Black women). The majority of women also achieved 80% of days adherent using MEMS caps, with a greater adherence in Black women. Conclusions: This study demonstrates the feasibility, acceptability, and early promise of the effectiveness of an MI counseling-based intervention to promote ET adherence and prevent breast cancer recurrence in diverse populations. Full article
(This article belongs to the Special Issue Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity)
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12 pages, 430 KiB  
Article
The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women
by Victoria L. Champion, Patrick O. Monahan, Timothy E. Stump, Erika B. Biederman, Eric Vachon, Mira L. Katz, Susan M. Rawl, Ryan D. Baltic, Carla D. Kettler, Natalie L. Zaborski and Electra D. Paskett
Cancers 2022, 14(18), 4354; https://doi.org/10.3390/cancers14184354 - 7 Sep 2022
Cited by 6 | Viewed by 2965
Abstract
Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and [...] Read more.
Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and the DVD plus patient navigation (PN) intervention vs. Usual Care (UC) for increasing the percentage of rural women (aged 50 to 74) UTD for breast cancer screening, as part of a larger study. Four hundred and two women who were not UTD for breast cancer screening, eligible, and between the ages of 50 to 74 were recruited from rural counties in Indiana and Ohio. Consented women were randomly assigned to one of three groups after baseline assessment of sociodemographic variables, health status, beliefs related to cancer screening tests, and history of receipt of guideline-based screening. The mean age of participants was 58.2 years with 97% reporting White race. After adjusting for covariates, 54% of women in the combined intervention (DVD + PN) had a mammogram within the 12-month window, over 5 times the rate of becoming UTD compared to UC (OR = 5.11; 95% CI = 2.57, 10.860; p < 0.001). Interactions of the intervention with other variables were not significant. Significant predictors of being UTD included: being in contemplation stage (intending to have a mammogram in the next 6 months), being UTD with other cancer screenings, having more disposable income and receiving a reminder for breast screening. Women who lived in areas with greater Area Deprivation Index scores (a measure of poverty) were less likely to become UTD with breast cancer screening. For rural women who were not UTD with mammography screening, the addition of PN to a tailored DVD significantly improved the uptake of mammography. Attention should be paid to certain groups of women most at risk for not receiving UTD breast screening to improve breast cancer outcomes in rural women. Full article
(This article belongs to the Special Issue Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity)
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11 pages, 951 KiB  
Article
Long-term Mammography Utilization after an Initial Randomized Intervention Period by all Underserved Chilean Women in the Clinics
by Klaus Puschel, Andrea Rioseco, Gabriela Soto, Mario Palominos, Augusto León, Mauricio Soto and Beti Thompson
Cancers 2022, 14(15), 3734; https://doi.org/10.3390/cancers14153734 - 31 Jul 2022
Cited by 2 | Viewed by 1488
Abstract
Chile has one of the highest rates of breast cancer in Latin America. Mammography rates among women, especially those of low socioeconomic status (SES), are thought to contribute to high breast cancer morbidity and mortality. A successful randomized controlled trial among women aged [...] Read more.
Chile has one of the highest rates of breast cancer in Latin America. Mammography rates among women, especially those of low socioeconomic status (SES), are thought to contribute to high breast cancer morbidity and mortality. A successful randomized controlled trial among women aged 50 to 70 in a low-SES primary care clinic in Chile led to a significant increase in mammography screening rates in a two-year intervention trial. This study assesses the sustainability of the intervention after ten years and identifies factors that might have been associated with a long-term effect using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The mammography rates among women aged 50 to 70 in the low-SES intervention clinic were compared to two populations of women aged 50 to 70 from middle-SES clinics and to national data. Qualitative data were used to answer questions of adoption, implementation, and maintenance, while quantitative data assessed the reach and effectiveness. After ten years, low-SES women at the intervention clinic maintained significantly higher mammography screening rates vs. middle-SES women at the comparison clinics (36.2% vs. 30.1% and 19.4% p < 0.0001). Women of a low SES at the intervention clinic also had significantly higher screening rates compared to women of a low SES at a national level (44.2% vs. 34.2% p < 0.0001). RE-AIM factors contributed to understanding the long-term difference in rates. Mailed contact, outreach interventions, and the integration of health promoters as part of the Community Advisory Board were important factors associated with the effects observed. This study provides information on factors that could contribute to reducing the social gap on breast cancer screening. Full article
(This article belongs to the Special Issue Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity)
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13 pages, 778 KiB  
Article
A Digital Cancer Ecosystem to Deliver Health and Psychosocial Education as Preventive Intervention
by Laura Ciria-Suarez, Laura Costas, Aida Flix-Valle, Maria Serra-Blasco, Joan C. Medina and Cristian Ochoa-Arnedo
Cancers 2022, 14(15), 3724; https://doi.org/10.3390/cancers14153724 - 30 Jul 2022
Cited by 5 | Viewed by 2544
Abstract
Health education and psychosocial interventions prevent emotional distress, and the latter has been shown to have an impact on survival. In turn, digital health education interventions may help promote equity by reaching a higher number of cancer patients, both because they avoid journeys [...] Read more.
Health education and psychosocial interventions prevent emotional distress, and the latter has been shown to have an impact on survival. In turn, digital health education interventions may help promote equity by reaching a higher number of cancer patients, both because they avoid journeys to the hospital, by and having a better efficiency. A total of 234 women recently diagnosed with breast cancer in a comprehensive cancer center used the digital ecosystem ICOnnecta’t from March 2019 to March 2021. ICOnnecta’t consists of four care levels, provided to patients according to their level of distress. The second level of this intervention consists of an educational campus, which was analyzed to track users’ interests and their information-seeking behavior. Overall, 99 out of 234 women (42.3%) used the educational campus. There were no significant differences in sociodemographic and clinical variables between the campus users and non-users. Among users, the median number of resources utilized per user was four (interquartile range: 2–9). Emotional and medical resources were the contents most frequently viewed and the audiovisual format the most consulted (p < 0.01). Resources were used mainly within the first three months from enrolment. Users who were guided to visit the virtual campus were more active than spontaneous users. Offering an early holistic health educational platform inside a digital cancer ecosystem, with health professionals involved, can reach more patients, promoting equity in the access of cancer information and prevention, from the very beginning of the disease. Full article
(This article belongs to the Special Issue Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity)
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Review

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13 pages, 292 KiB  
Review
Evidence-Based Interventions for Reducing Breast Cancer Disparities: What Works and Where the Gaps Are?
by Rebecca D. Kehm, Adana A. M. Llanos, Jasmine A. McDonald, Parisa Tehranifar and Mary Beth Terry
Cancers 2022, 14(17), 4122; https://doi.org/10.3390/cancers14174122 - 26 Aug 2022
Cited by 2 | Viewed by 2629
Abstract
The National Cancer Institute (NCI) has established an online repository of evidence-based cancer control programs (EBCCP) and increasingly calls for the usage of these EBCCPs to reduce the cancer burden. To inventory existing EBCCPs and identify remaining gaps, we summarized NCI’s EBCCPs relevant [...] Read more.
The National Cancer Institute (NCI) has established an online repository of evidence-based cancer control programs (EBCCP) and increasingly calls for the usage of these EBCCPs to reduce the cancer burden. To inventory existing EBCCPs and identify remaining gaps, we summarized NCI’s EBCCPs relevant to reducing breast cancer risk with an eye towards interventions that address multiple levels of influence in populations facing breast cancer disparities. For each program, the NCI EBCCP repository provides the following expert panel determined summary metrics: (a) program ratings (1–5 scale, 5 best) of research integrity, intervention impact, and dissemination capability, and (b) RE-AIM framework assessment (0–100%) of program reach, effectiveness, adoption, and implementation. We quantified the number of EBCCPs that met the quality criteria of receiving a score of ≥3 for research integrity, intervention impact, and dissemination capability, and receiving a score of ≥50% for available RE-AIM reach, effectiveness, adoption, and implementation. For breast cancer risk reduction, we assessed the presence and quality of EBCCPs related to physical activity (PA), obesity, alcohol, tobacco control in early life, breastfeeding, and environmental chemical exposures. Our review revealed several major gaps in EBCCPs for reducing the breast cancer burden: (1) there are no EBCCPs for key breast cancer risk factors including alcohol, breastfeeding, and environmental chemical exposures; (2) among the EBCPPs that exist for PA, obesity, and tobacco control in early life, only a small fraction (24%, 17% and 31%, respectively) met all the quality criteria (≥3 EBCCP scores and ≥50% RE-AIM scores) and; (3) of those that met the quality criteria, only two PA interventions, one obesity, and no tobacco control interventions addressed multiple levels of influence and were developed in populations facing breast cancer disparities. Thus, developing, evaluating, and disseminating interventions to address important risk factors and reduce breast cancer disparities are needed. Full article
(This article belongs to the Special Issue Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity)
12 pages, 859 KiB  
Review
Strategies to Achieve Breast Health Equity in the St. Louis Region and Beyond over 15+ Years
by Bettina Drake, Aimee James, Heidi Miller, Akila Anandarajah, Kia L. Davis, Sheryll Jackson, Graham A Colditz and Vetta Sanders Thompson
Cancers 2022, 14(10), 2550; https://doi.org/10.3390/cancers14102550 - 23 May 2022
Cited by 6 | Viewed by 2678
Abstract
Community-based participatory strategies are a promising approach to addressing disparities in community health outcomes. This paper details the efforts of Siteman Cancer Center to achieve breast health equity over the past 15+ years. We begin by describing the activities and successes arising from [...] Read more.
Community-based participatory strategies are a promising approach to addressing disparities in community health outcomes. This paper details the efforts of Siteman Cancer Center to achieve breast health equity over the past 15+ years. We begin by describing the activities and successes arising from our breast health community partnerships including identifying priorities, developing recommendations, and implementing patient navigation services to advance breast health. This system-wide coordinated navigation approach that includes primary and specialty care providers helped to increase potential impact on reducing breast health disparities by expediting care, increasing care efficiency, and standardizing referral procedures across systems for all women including those who are uninsured and underinsured. We also discuss a mobile mammography unit that has been deployed to serve women living in both urban and rural regions. The van reached a particularly vulnerable population that was mostly poor, uninsured, and with limited educational backgrounds regardless of their zip code of service. This work shows that collaborations between academic and community partners have resulted in decreased late stage at diagnosis and improved access to mammography. Furthermore, we offer lessons learned and recommendations that may be applicable to other communities. Full article
(This article belongs to the Special Issue Breast Cancer: Early Detection and Prevention Strategies to Achieve Equity)
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