Connect with us

Spread & Containment

Significant disparities in breast cancer care persist, but surgeons can drive change

Key takeaways Credit: Please credit the American College of Surgeons Key takeaways Inequitable access to breast cancer care: Treatment options for breast…



Key takeaways

Credit: Please credit the American College of Surgeons

Key takeaways

  • Inequitable access to breast cancer care: Treatment options for breast cancer are increasing, but many groups still do not have equitable access to preventative services, such as screening mammograms, and new therapies or drugs.
  • Wide spectrum of disparities: Screening, genetic testing, reconstruction, and fertility preservation are four significant areas where disparities exist and where surgeons should maintain awareness.
  • Surgeons can drive change: Surgeons can raise the standard of care at their institutions by improving their understanding of these disparities and advocating for their patients.

CHICAGO: Surgeons can play a key role in reducing breast cancer disparities by increasing their awareness of where disparities exist and having open conversations with their patients about their needs to initiate referrals early on in their care, according to a new collective review article published in the Journal of the American College of Surgeons (JACS).

Despite improved screening and treatment options for breast cancer — the most common cancer diagnosed in women excluding skin cancers — many populations face significant barriers to screening and treatment options for breast cancer.

Following a well-received in-person panel discussion on breast cancer disparities held at the American College of Surgeons (ACS) Clinical Congress in October 2022, an interdisciplinary team of clinicians, which included surgeons, a radiologist, and public health researchers, convened to explore these disparities in more detail for a research article in JACS.

“Many breast surgeons may already be aware of some of the disparities that exist in regard to breast cancer care, but we wanted to illustrate the wide scope of the problems and raise awareness among general surgeons and other healthcare provides who treat breast cancer patients,” said Kathie-Ann Joseph, MD, MPH, FACS, senior author of the study and a professor of surgery and population health at New York University (NYU) Langone Health. “Whether you work in a rural or city hospital, these are real issues that we deal with and face every day.”

Areas of Disparity

While disparities are multifactorial, the researchers identified four specific areas where disparities remain concerning: screening, genetic testing, reconstruction, and access to fertility-preservation treatments for cancer patients (also known as oncofertility).

“These are topics that are often overlooked. We sort of assume that most women who are diagnosed with breast cancer may require these services and that they are readily available. But unfortunately, depending on geography or the type of hospital that a patient is being treated, many of these services may not be available,” explained Dr. Joseph, who also serves as vice-chair for diversity and health equity at NYU Langone Health. “Or if they are available, certain patients may not have the full breadth of access for some of these services or treatments.”

  • Variable access to screening: Many women may not have access to or be able to afford some of the latest screening technologies — including 3D mammography, breast ultrasound, and breast magnetic resonance imaging (MRI) — even with health insurance. These technologies are increasingly used to screen for breast cancer and monitor women at high risk of the disease and/or who have increased breast density. The pandemic has further exacerbated these challenges by delaying screening for some women.

“There are differences in what screening services are offered, so I think we need to be asking: How do we make sure that people have equal access to the latest technologies so that they can anticipate the same great outcomes that other women can have?,” said Angelena Crown, MD, FACS, first author of the study and a breast surgeon at Swedish Cancer Institute in Seattle, Washington. “If we can find more cancers at an earlier stage, then we can really start seeing improvements, not only in survival but also in the quality of life associated with the treatments that are required for more advanced breast cancers.”

  • Genetic counseling and testing: Cancer care that integrates knowledge of genetics remains critical for the health of patients with cancer and their families. However, most genes associated with an increased breast cancer risk were first identified in Northern European Whites. As a result, women from different racial and ethnic groups who undergo genetic testing are more likely to receive inconclusive results, also known as variants of uncertain significance (VUS).

“I think there is a need for patient and clinician education about the importance of genetic testing for breast cancer prevention, screening, and targeted therapies,” said Allison Kurian, MD, MSc, a study co-author and professor of medicine and population health at Stanford Medicine. “It is also important for surgeons to recognize the unequal burden of VUS results. Surgeons should be ready to explain the implications of VUS results to patients and refer them to additional genetic counseling when appropriate.”

  • Access to fertility preservation: A growing number of women of childbearing age (* For these women, fertility preservation is vital for family planning purposes but can be cost-prohibitive for a large majority of patients.

“It’s really important for providers to think about the quality of life that these women are going to have. Most of these women are going to be diagnosed with curable disease, meaning anything less than stage 4, and they are expected to have long, healthy lives,” Dr. Crown said.

  • Reconstruction surgery: Patients who undergo a mastectomy have several options for reconstruction, including implant reconstruction or tissue (flap) reconstruction, where a woman’s own tissue from other parts of her body is used to reconstruct the breast. However, even with laws requiring some states to cover reconstruction, insurance and geography may still dictate what kind of reconstruction a patient is likely to receive.

“Oftentimes, having a tissue-based reconstruction is ideal for many patients but that may not be feasible, depending on the type of training the plastic surgeon has, and the availability of the procedure at a specific hospital,” Dr. Joseph explained. Language and health literacy barriers can further impact the information available to a patient.

Strategies to Improve Care

Recognizing the magnitude of these disparities, the researchers outlined key steps that breast cancer centers and surgeons can take to improve equitable care:

  • Advocate for patient navigation programs, which can improve rates of screening and increase patient satisfaction.
  • Open treatment centers in underserved communities, and when possible, implement flexible hours and help patients with access to travel and childcare assistance.
  • Assist with community-led health efforts and produce educational materials in a variety of formats and languages.
  • Improve the representation of minority groups in clinical trial research and improve diversity within the oncology workforce through dedicated programming and mentorship opportunities.
  • Increase funding of safety-net hospitals, which often treat a large proportion of low-income, uninsured, and other vulnerable populations, and increase research dedicated to addressing health disparities.
  • Refer patients, independent of their insurance status, to resources, such as grants or charitable programs, that can assist with coverage for genetic screening and fertility preservation, when possible.
  • Integrate genetic testing into oncology care by employing a genetic counselor in oncology clinics and/or offering online counseling and testing protocol, which may extend access to patients in rural areas or to those who have limited access to transportation and/or time off from work.

Unique Role of Surgeons

Surgeons are often the first point of contact in a patient’s journey through breast cancer. Surgeons can be important drivers of change, the authors noted, by maintaining their awareness of existing disparities and providing additional resources to patients when possible.

“One way to make a difference today is to be aware that access to breast cancer services is sub-optimal in many places, and that if you help your individual patients get access to necessary screening or treatment, you are already doing something good,” Dr. Crown said. “By initiating conversations early, surgeons can actually expedite patient care and give patients access to more options. We can really shape what that future life looks like for patients starting right there on day one in the office.”

“Finding small ways to help address disparities, even if it’s just referring a patient for one program that they would not have known about before, can make a huge difference for all our patients who are diagnosed with breast cancer,” Dr. Joseph added. “It just starts with that one small step. There is hope, but it requires work.”

Study coauthors are Soudabeh Fazeli, MD, MPH and Daniela A. Ochoa, MD, FACS.

The study authors have no relevant disclosures to report.

This article is published as an article in press on the JACS website.

Citation: Crown A, Fazeli S, Kurian A, et al. Disparities in Breast Cancer Care: Current State of Access to Screening, Genetic Testing, Oncofertility, and Reconstruction. Journal of American College of Surgeons. DOI: 10.1097/XCS.0000000000000647.


* Trivers KF, Fink AK, Partridge AH, et al. “Estimates of young breast cancer survivors at risk for infertility in the US.” The oncologist 19, no. 8 (2014): 814-822.# # #

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons. 

The Journal of the American College of Surgeons (JACS) is the official scientific journal of ACS. Each month, JACS publishes peer-reviewed original contributions on all aspects of surgery, with the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons.

Read More

Continue Reading

Spread & Containment

DNAmFitAge: Biological age indicator incorporating physical fitness

“We expect DNAmFitAge will be a useful biomarker for quantifying fitness benefits at an epigenetic level and can be used to evaluate exercise-based interventions.”…



“We expect DNAmFitAge will be a useful biomarker for quantifying fitness benefits at an epigenetic level and can be used to evaluate exercise-based interventions.”

Credit: 2023 McGreevy et al.

“We expect DNAmFitAge will be a useful biomarker for quantifying fitness benefits at an epigenetic level and can be used to evaluate exercise-based interventions.”

BUFFALO, NY- June 7, 2023 – A new research paper was published in Aging (listed by MEDLINE/PubMed as “Aging (Albany NY)” and “Aging-US” by Web of Science) Volume 15, Issue 10, entitled, “DNAmFitAge: biological age indicator incorporating physical fitness.”

Physical fitness is a well-known correlate of health and the aging process and DNA methylation (DNAm) data can capture aging via epigenetic clocks. However, current epigenetic clocks did not yet use measures of mobility, strength, lung, or endurance fitness in their construction. 

In this new study, researchers Kristen M. McGreevy, Zsolt Radak, Ferenc Torma, Matyas Jokai, Ake T. Lu, Daniel W. Belsky, Alexandra Binder, Riccardo E. Marioni, Luigi Ferrucci, Ewelina Pośpiech, Wojciech Branicki, Andrzej Ossowski, Aneta Sitek, Magdalena Spólnicka, Laura M. Raffield, Alex P. Reiner, Simon Cox, Michael Kobor, David L. Corcoran, and Steve Horvath from the University of California Los Angeles, University of Physical Education, Altos Labs, Columbia University Mailman School of Public Health, University of Hawaii, University of Edinburgh, National Institute on Aging, Jagiellonian University, Pomeranian Medical University in Szczecin, University of Łódź, Central Forensic Laboratory of the Police in Warsaw, Poland, University of North Carolina at Chapel Hill, University of Washington, and University of British Columbia develop blood-based DNAm biomarkers for fitness parameters including gait speed (walking speed), maximum handgrip strength, forced expiratory volume in one second (FEV1), and maximal oxygen uptake (VO2max) which have modest correlation with fitness parameters in five large-scale validation datasets (average r between 0.16–0.48). 

“These parameters were chosen because handgrip strength and VO2max provide insight into the two main categories of fitness: strength and endurance [23], and gait speed and FEV1 provide insight into fitness-related organ function: mobility and lung function [8, 24].”

The researchers then used these DNAm fitness parameter biomarkers with DNAmGrimAge, a DNAm mortality risk estimate, to construct DNAmFitAge, a new biological age indicator that incorporates physical fitness. DNAmFitAge was associated with low-intermediate physical activity levels across validation datasets (p = 6.4E-13), and younger/fitter DNAmFitAge corresponds to stronger DNAm fitness parameters in both males and females. 

DNAmFitAge was lower (p = 0.046) and DNAmVO2max is higher (p = 0.023) in male body builders compared to controls. Physically fit people had a younger DNAmFitAge and experienced better age-related outcomes: lower mortality risk (p = 7.2E-51), coronary heart disease risk (p = 2.6E-8), and increased disease-free status (p = 1.1E-7). These new DNAm biomarkers provide researchers a new method to incorporate physical fitness into epigenetic clocks.

“Our newly constructed DNAm biomarkers and DNAmFitAge provide researchers and physicians a new method to incorporate physical fitness into epigenetic clocks and emphasizes the effect lifestyle has on the aging methylome.”

Read the full study: DOI: 

Corresponding Authors: Kristen M. McGreevy, Zsolt Radak, Steve Horvath

Corresponding Emails:,, 

Keywords: epigenetics, aging, physical fitness, biological age, DNA methylation

Sign up for free Altmetric alerts about this article:


About Aging-US:

Launched in 2009, Aging publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways.

Please visit our website at​​ and connect with us:

  • SoundCloud
  • Facebook
  • Twitter
  • Instagram
  • YouTube
  • LabTube
  • LinkedIn
  • Reddit
  • Pinterest


Click here to subscribe to Aging publication updates.

For media inquiries, please contact


Aging (Aging-US) Journal Office

6666 E. Quaker Str., Suite 1B

Orchard Park, NY 14127

Phone: 1-800-922-0957, option 1


Read More

Continue Reading


Martha Stewart Has a Spicy Take on Americans Who Want to Work From Home

This half-baked take might need to stay in the oven a little longer.



Lifestyle icon Martha Stewart has been on a roll when it comes to representing vivacious women over 60. Whether she's teaming up to charm audiences alongside her BFF Snoop Dogg, poking fun at Elon Musk, or starring as Sports Illustrated's Swimsuit Issue cover model, Martha stays busy. 

Her most recent publicity moment, however, doesn't have the same wholesome feeling Stewart brings to the table. In an interview with Footwear News, the DIY-queen had some choice words about Americans who want to continue working from home after covid-19 lockdown shut down offices.

“You can’t possibly get everything done working three days a week in the office and two days remotely," the cozy-home guru said. "Look at the success of France with their stupid … you know, off for August, blah blah blah. That’s not a very thriving country. Should America go down the drain because people don’t want to go back to work?”

Well, that's certainly a viewpoint. A lot to unpack there. Many online were confused--after all, didn't Stewart basically make her career by "working from home?"

Sitting down with The Today Show, Stewart elaborated on her controversial stance. It seems she's confusing "work from home" with a three-day workweek. 

"I'm having this argument with so many people these days. It's just that my kind of work is very creative and is very collaborative. And I cannot really stomach another zoom. [...But] I hate going to an office, it's empty. During COVID I took every precaution. We [...] set up an office at [...] my home[...] Now we're our offices and our three day work week, I just don't agree with it," Stewart tells viewers. 

"It's frightening because if you read the economic news and look at what's happening everywhere in the world, a three-day workweek doesn't get the work done, doesn't get the productivity up. It doesn't help with the economy and I think that's very important."

Read More

Continue Reading


How cashless societies can boost financial inclusion — with the right safeguards

The UK could learn a lot from developing economies about using digital payments to boost financial inclusion.




Accepting digital payments. WESTOCK PRODUCTIONS/Shutterstock

Cashless societies, where transactions are entirely digital, are gaining traction in many parts of the world, particularly after a pandemic-era boom in demand for online banking.

Improvements in digital payment infrastructure such as mobile payments, digital currencies and online banking, make it more convenient for people and businesses to buy and sell things without using cash. Even the Bank of England is looking into how a digital pound might work, showing the potential for a significant shift from physical cash to digital payments in the UK.

Read more: How a digital pound could work alongside cryptocurrencies

Fintech companies have accelerated the transition towards cashless payments with innovations including mobile payment apps, digital wallets, cryptocurrencies and online banking services. The COVID pandemic was also a tipping point that created unprecedented appetite for digital transactions. Fintechs emerged as a life line for many during lockdowns, particularly vulnerable populations that needed emergency lines of credit and ways to make and receive payments.

By 2021, approximately 71% of adults in developing countries had bank accounts. But this leaves nearly 30% of the population still needing access to essential financial products and services. Fintechs can provide more affordable and accessible financial services and products. This helps boost financial inclusion, particularly for the “unbanked”, or those without a bank account.

In the UK, around 1.3 million people, roughly 4% of the population, lack access to banking services. The government and financial institutions have worked together to promote the adoption of digital payments, and the UK’s Request to Pay service allows people and businesses to request and make payments using digital channels such as Apple Pay and Google Pay.

But other countries are moving faster towards a cashless society. In Sweden, only about 10% of all payments were made in cash in 2020. This move towards cashless payments in the country has been facilitated by mobile payment solutions like Swish, which people can use to send and receive money via mobile phone.

Boosting financial inclusion

India has gone even further. In less than a decade, the country has become a digital finance leader. It has also made significant progress in promoting digital financial inclusion, mainly through the government’s flagship programme, the Pradhan Mantri Jan Dhan Yojana (PMJDY).

India’s banks also participate in mobile payment solutions like Unified Payments Interface (UPI), which can connect multiple accounts via one app. India’s digital infrastructure, known as the India Stack also aims to expand financial inclusion by encouraging companies to develop fintech solutions.

Many developing economies are using digitalisation to boost financial inclusion in this way. Kenya introduced its M-Pesa mobile money service in 2007. While microfinance institutions that provide small loans to low-income individuals and small businesses were first introduced in Bangladesh in the 1970s via the Grameen Bank project.

Digital lending has also grown in India in recent years. Its fintechs use algorithms and data analytics to assess creditworthiness and provide loans quickly and at a lower cost than traditional banks.

These innovative platforms have helped to bridge the gap between the formal financial system and underserved populations – those with low or no income – providing fast access to financial services. By removing barriers such as high transaction costs, lack of physical branches and some credit history requirements, fintech companies can reach a wider range of customers and provide financial services that are tailored to their needs.

It’s the tech behind these systems that helps fintechs connect with their customers. The increased use of digital payment methods generates a wealth of data to gain insights into consumer behaviour, spending patterns and other relevant information that can be used to further support a cashless society.

Helping the UK’s unbanked

Countries like the UK could also promote digital financial inclusion to help unbanked people. But this would require a combination of government support, innovation and the widespread adoption of mobile payment solutions.

There are some significant challenges to overcome to create a true – and truly fair – cashless economy. For example, a cashless system could exclude people who do not have access to digital payment methods, such as the elderly or low-income populations. According to a recent study by Age UK, 75% of over 65s with a bank account said they wanted to conduct at least one banking task in person at a bank branch, building society or post office.

Providing more cashless options could also increase the risk of cybercrime, digital fraud such as phishing scams and data breaches – particularly among people that aren’t as financially literate.

There is a dark side to fintech: algorithm biases and predatory lending practices negatively affect vulnerable and minority groups as well as women. Even major financial firms such as Equifax, Visa and Mastercard can get compromised by data breaches, creating valid concerns about data security for many people.

Cross-border transfer of personal data by fintech companies also concerns regulators, but there is still a lack of internationally recognised data protection standards. This should be addressed as the trend towards cashless societies continues.

Two hands hold a fan of GBP banknotes: £5, £10, £20, £50.
Paying with cash. Nieves Mares/Shutterstock

Building guardrails

Regulations affect how fintech companies can provide financial services but ensure they operate within the law. Since fintech companies generally aim to disrupt markets, however, this can create a complex relationship with regulators.

Collaboration between regulators and fintech companies will boost understanding of these innovative business models and help shape future regulatory frameworks. Countries like India have shown the way in this respect. An innovation hub run by UK regulator the Financial Conduct Authority is a good start. It supports product and service launches and offers access to synthetic data sets for testing and development.

Fintech can help finance become more inclusive. But it needs policies and regulations that support innovation, promote competition, ensure financial stability and – most importantly – to help protect the citizens of these new cashless societies.

Thankom Arun does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Read More

Continue Reading