Smetherman Dana, Biggs Kelly, Fayanju Oluwadamilola M, Grosskreutz Scott, Khan Zahra, Malak Sharp, Moseley Tanya, Smith-Graziani Demetria, Valero Vicente, Lightfoote Johnson
Ochsner Health, Department of Radiology, New Orleans, LA, USA.
James E. Van Zandt, VA Medical Center, Department of Radiology, Altoona, PA, USA.
J Breast Imaging. 2021 Nov 16;3(6):712-720. doi: 10.1093/jbi/wbab081.
Since the 1980s, the mortality rate from breast cancer in the United States has dropped almost 40%. The quality of life and survival gains from early detection and improved treatment have not been shared equally by all ethnic groups, however. Many factors, including social determinants of health, unequal access to screening and oncologic care, and differences in incidence, tumor biology, and risk factors, have contributed to these unequal breast cancer outcomes. As breast radiologists approach their own patients, they must be aware that minority women are disproportionately affected by breast cancer at earlier ages and that non-Hispanic Black and Hispanic women are impacted by greater severity of disease than non-Hispanic White women. Guidelines that do not include women younger than 50 and/or have longer intervals between examinations could have a disproportionately negative impact on minority women. In addition, the COVID-19 pandemic could worsen existing disparities in breast cancer mortality. Increased awareness and targeted efforts to identify and mitigate all of the underlying causes of breast cancer disparities will be necessary to realize the maximum benefit of screening, diagnosis, and treatment and to optimize quality of life and mortality gains for all women. Breast radiologists, as leaders in breast cancer care, have the opportunity to address and reduce some of these disparities for their patients and communities.
自20世纪80年代以来,美国乳腺癌死亡率下降了近40%。然而,早期检测和治疗改善带来的生活质量提升和生存获益并未在所有种族群体中平等共享。包括健康的社会决定因素、筛查和肿瘤护理的不平等获取、发病率、肿瘤生物学和风险因素的差异等许多因素,都导致了这些不平等的乳腺癌结果。当乳腺放射科医生面对自己的患者时,他们必须意识到少数族裔女性在更年轻的年龄就受到乳腺癌的影响更为严重,而且非西班牙裔黑人和西班牙裔女性比非西班牙裔白人女性受到的疾病严重程度影响更大。不包括50岁以下女性和/或检查间隔时间更长的指南可能会对少数族裔女性产生不成比例的负面影响。此外,新冠疫情可能会加剧乳腺癌死亡率方面现有的差距。提高认识并采取针对性措施来识别和减轻乳腺癌差距的所有潜在原因,对于实现筛查、诊断和治疗的最大益处以及优化所有女性的生活质量和死亡率改善是必要的。乳腺放射科医生作为乳腺癌护理的领导者,有机会为他们的患者和社区解决并减少其中一些差距。