Reducing racial disparities in breast

Reducing racial disparities in breast cancer care

Plastic surgeons’ efforts empower medically underserved areas

By Olatomide Familusi, MD, MS, and Paris Butler, MD, MPH

Shortly after the introduction of the Women’s Health and Cancer Rights Act (WHCRA) in 1998,

several studies brought to light the glaring disparity in the rates of breast reconstruction between Caucasian women and women of color. These differences remained regardless of a woman’s insurance status, socioeconomic status or geographic access to a plastic surgeon.

One study from MD Anderson Cancer Center found that African-American women received breast reconstruction at half the rate of their Caucasian counterparts. Another study revealed that African-American women were less likely to be offered referrals for breast reconstruction, less likely to accept referrals if offered, less likely to be offered reconstruction and less likely to choose reconstruction if offered.

We now understand that the cause of the observed disparity is multifactorial, but awareness and health literacy appear to play a significant role. In the wake of the 21st anniversary of the WHCRA, we would like to reflect on some of the strides taken at the University of Pennsylvania Health System (UPHS) to improve breast reconstruction awareness among women of color, what we have learned in doing so and how we plan to continue this work.

Dr. Butler's awareness event.

Community empowerment

In collaboration with The PSF, the Abramson Cancer Center at the University of Pennsylvania, breast surgeons within the UPHS Department of Surgery and a dedicated group of residents, medical students and research fellows, our plastic and reconstructive surgery division organizes an annual symposium focused on educating local, underserved communities about breast reconstruction. To build stronger community ties and reach as many Philadelphians as possible, the symposium is held at a church in a different section of the city each year.

Participants spend an afternoon learning about breast health, breast cancer screening, treatment modalities and breast reconstruction options. Attendees have the opportunity to listen to patient testimonials and participate in a panel-based Q&A session. One of the many highlights of the day is the exhibitor fair, during which samples of implant devices, wigs, bras and prostheses are available for patients to experience. To date, more than 200 community members have participated, with many returning each year, bringing friends and family members with them.

The pre- and post-symposium surveys administered in the past three years brought to light some of the knowledge gaps and misconceptions about breast reconstruction among our participants, which we focus on in subsequent symposia. Less than half of the attendees at our second annual symposium were aware that breast reconstruction was covered by insurance, and even fewer knew that contralateral balancing procedures – performed to create symmetry with the opposite breast – were similarly covered. We also noted that although half of our program participants were college educated, many demonstrated poor baseline knowledge about breast health, breast cancer and breast reconstruction. This emphasizes the fact that higher education does not necessarily translate directly to health literacy. Most importantly, we witnessed the Philadelphia community demonstrate a remarkable desire to be engaged and empowered. Year after year, we receive positive feedback and encouragement to repeat the symposium, and we truly believe that the key to raising awareness about breast reconstruction among women of color in a sustainable way is to focus on community engagement and empowerment.

Naturally, not all women who undergo a mastectomy for breast cancer will go on to have breast reconstruction. It remains a very personal choice. One attendee told us she frequently wondered what a reconstructed breast looked like and never seriously considered reconstruction for herself. Nevertheless, with the information she received at our symposium, she scheduled an appointment to learn more.

Plastic surgeons must exercise our due diligence in raising awareness about breast reconstruction. It is incumbent on us to help ensure that every woman – regardless of her age or race/ethnicity – has the opportunity to make an educated decision about what is best for them. We plan to continue these symposiums annually at new locations across Philadelphia with the hope that our success can serve as a template for other institutions and practices across the country.

ASPS member Paris D. Butler, MD, MPH is an assistant professor in the Division of Plastic Surgery at the University of Pennsylvania. His clinical interests reside in both reconstructive and cosmetic plastic surgery. He is board-certified by both the American Board of Surgery and the American Board of Plastic Surgery. Additionally, Dr. Butler has a MPH in health policy and management with a special certificate in minority health. He currently serves on the American College of Surgeons’ (ACS) Committee on Surgical Health Care Disparities as well as the ASPS Diversity Task Force.

Olatomide (Tomi) Familusi, MD, MS, is a fourth-year plastic surgery integrated resident at the University of Pennsylvania. She completed her medical training at Albert Einstein College of Medicine in New York, where she also attained a master’s degree in Clinical Research Methods. Her clinical interests thus far include body contouring, microsurgical reconstruction and aesthetic plastic surgery. Her research interests focus on patient education and health care disparities.