Disparities in Time to Treatment for Breast Cancer: Existing Knowledge and Future Directions in the COVID-19 Era.

Purpose of Review: Despite significant advances in detection and treatment for breast cancer, the breast cancer mortality rate for Black women remains 40% higher than that for White women. Timely work-up and treatment improve outcomes, yet no gold standard exists for which to guide providers. Recent Findings: A large body of literature demonstrates disparities in time to treatment for breast cancer, and most studies show that Black women receive treatment later than their White counterparts. The COVID-19 pandemic has been projected to worsen these disparities, but the extent of this impact remains unknown. Summary: In this review, we describe the available evidence on disparities in time to treatment, potential drivers, and possible mitigation strategies. Future research must address how the COVID-19 pandemic has impacted the timely treatment of breast cancer patients, particularly populations vulnerable to disparate outcomes. Improved access to multidisciplinary breast programs, patient navigation services, and establishment of standards for timely treatment are necessary.

Breast Cancer Disparities and the Digital Divide.

Purpose of Review: Socioeconomically disadvantaged populations and minority groups suffer from high breast cancer mortality, a disparity caused by decreased access to specialty care, lower treatment adherence, co-morbidities, and genetic predisposition for biologically aggressive breast tumor subtypes. Telehealth has the potential to mitigate breast cancer disparities by increasing access to specialty care and health information. However, unequal access to high-speed/broadband internet service and telehealth itself magnifies breast cancer disparities in vulnerable populations. This review evaluates the impact of the digital divide on breast cancer outcomes, as well as strategies for leveraging telehealth to reduce breast cancer disparities. Recent Findings: There is a paucity of research specific to employing telehealth to address breast cancer disparities. Previous studies provide examples of telehealth utilization for increasing screening mammography, in addition to improving access to breast cancer care, including breast cancer specialist, nurse navigators, and clinical trials. Telehealth can also be used as an approach to risk reduction, with strategies to support weight management and genetic testing. Summary: Eliminating the digital divide holds enormous potential for mitigating breast cancer disparities through an intentional focus on improving access to telehealth. With increased accessibility, resource allocation, and improved digital infrastructure, telehealth can be used to address disparities in early detection, quality of breast cancer care, treatment adherence, and risk assessment. Further research is essential to elucidate best practices in breast cancer telehealth approaches in underserved communities.

Active antiracism through surgical education.

INTRODUCTION: Disparities in surgical outcomes are well documented. Racial/ethnic minorities are also disproportionately underrepresentated in surgery; however, most surgeons do not acknowledge the existence of disparities. Diversity, equity, and inclusion (DEI) education in surgery is needed, yet DEI education is often confined to designated diversity lectures, limiting depth of content. Underrepresented minorities (URMs) are also more likely to be tasked with leading DEI initiatives, perpetuating the minority tax and limiting non-URM engagement. METHODS: A DEI curriculum was implemented in a general surgery department, inclusive of programming at morbidity and mortality (M&M) and grand rounds (GR). RESULTS/LESSONS LEARNED: After implementing a DEI curriculum there was a significant increase in DEI topics at M&M (0% versus 27.3%; p < 0.01) and GR (0% versus 18.4%; p < 0.001). The majority of DEI M&Ms were presented by non-URMs (88.89%). Most DEI GR were presented by URMs (55%). CONCLUSIONS: Structured integration of DEI initiatives into surgery department conferences may serve as a practical approach to increasing departmental awareness of disparities, expanding DEI engagement, and increasing academic recognition for DEI initiatives.