PSP Breast Cancer Series, Part 3: Derek Cody, MD, FACS, of Ohio’s Crystal Clinic Plastic Surgeons, and Hologic executive Jennifer Meade join the conversation to help educate patients and end healthcare disparities.

Read Part 1 of the PSP Breast Cancer Series: Plastic Surgery Practice and Hologic Celebrate National Cancer Survivors Month.

Read Part 2 of the PSP Breast Cancer Series: NJ Surgeon Says Wire-Free Hologic Localizer Reduces Oncoplastic Prep Stress.

According to the National Cancer Institute at the National Institutes of Health, people with low incomes, low health literacy, long travel distances to screening sites, or who lack health insurance, transportation to a medical facility, or paid medical leave are less likely to have recommended cancer screening tests or be treated according to guidelines than those who don’t encounter these obstacles. In addition, people who do not have reliable access to healthcare are more likely to be diagnosed with late-stage cancer that might have been treated more effectively if diagnosed much earlier.

In Part 3 of our PSP breast cancer series, Derek Cody, MD, FACS, a board-certified plastic and reconstructive surgeon at Crystal Clinic Plastic Surgeons in Ohio, and Jennifer Meade, division president of breast and skeletal health solutions at Hologic, share ideas on the ways and means oncoplastic surgeons and others can help close the gap in underserved communities.

Oncoplastic breast reconstruction is a type of immediate reconstruction that reshapes the remaining breast tissue after a partial mastectomy to restore breast form, Cody explains. At Crystal Clinic Plastic Surgeons, he works with colleagues and clinical staff at facility locations in Barberton, Beachwood, Canton, Green, Hudson, and Montrose. The group’s services cover the entire spectrum of plastic surgery, non-surgical, and facial rejuvenation procedures.

Meade served as Hologic’s vice president of US sales for breast and skeletal health, after joining the division in 2016 as its vice president of customer experience, service, and support. Throughout her tenure at Hologic, which began in 2006, she’s held positions in finance, sales, and commercial excellence.

We also bring back from earlier parts of this series: M. Michele Blackwood, MD, chief of section breast surgery at Rutgers Cancer Institute of New Jersey and professor of surgery at Rutgers Robert Wood Johnson Medical School, and Valerie Gorman, MD, FACS, chief of surgery and medical director of surgical services at the Baylor Scott and White Waxahachie, Texas Surgical Specialists/Texas Breast Center.

What are some of the healthcare disparities that breast cancer patients are facing?

Cody: The state of healthcare disparities as it pertains to breast reconstruction and women of color is similar to that observed in other areas of medicine. Studies have shown that women of color are less likely to consult with a plastic surgeon prior to cancer removal, are less likely to undergo breast reconstruction of any type, and less likely to have immediate breast reconstruction. This represents a significant opportunity for improvement as the psychosocial benefits of breast reconstruction are well documented.

Meade: Hologic believes that all women deserve equal access to resources that advance their health and wellness, regardless of race, geography, or socioeconomic standing. Alarmingly, while the incidence of breast cancer is about the same for Black and white women (Centers for Disease Control (CDC) and Prevention), the breast cancer death rate was 40% higher in Black women versus white women (American Cancer Society). Over the age of 50, that increases to 50%.

Blackwood: One of our biggest concerns during the COVID-19 global pandemic is people losing their healthcare insurance. We were afraid that patients who felt a lump in their breast wouldn’t come in for imaging or mammogram checks. We’re starting to see more advanced stages of breast cancer in patients than we did before the pandemic. I’m hoping it’s not going to be a growing trend.

The Robert Wood Johnson Barnabas Health (RWJBH) System truly supports breast cancer patients and inclusivity for all. Our surgeons and medical oncologists will take care of anybody regardless of their insurance status. In addition, we have the Affordable Health Care Act marketplace for patients to gain access to insurance coverage in New Jersey. This has helped a lot of our patients, especially during the pandemic.

Gorman: I tell my patients, please don’t ever stop coming in to see me for treatment because of a lack of finance—we’ll figure that part out. We’re going to take care of you, first and foremost.

In the state of Texas, we have pretty good resources for breast cancer patients who qualify for Medicaid. And hospitals typically offer resources for people on a sliding scale. There are also other charity foundations to help bridge the gap. While it may involve an extra step for the physician or clinical staff member to process an applicant’s paperwork for a program, our team is dedicated to doing the research to help every breast cancer patient find the resources needed for treatment. The important thing is for our staff to be able to connect with and serve patients in need, no matter what socio-economic status.

How else can health experts and organizations educate breast cancer patients and advocate to preserve the care and quality of human life?

Meade: To address the breast cancer death rate, we launched the Project Health Equality initiative in October 2020, designed to reduce breast health disparities by encouraging Black and Hispanic women to get annual mammograms beginning at age 40. And, for those women in underserved communities, Hologic and partners will provide access to superior breast cancer screening technology. The multi-pronged initiative includes the Black Women’s Health Imperative’s (BWHIs) P.O.W.E.R. of Sure campaign, which examines common barriers to early screening and encourages Black and Hispanic women to schedule and attend their annual mammograms.

In addition, in partnership with RAD-AID, Hologic is funding screening and diagnostic services to ensure there is a pathway for women to receive treatment. Our $15 million investment in this initiative will support innovative care, radiology, public education, and nurse navigation at multiregional sites specially selected by RAD-AID as clinical partners to provide critical screening, diagnostic breast imaging, and treatment for women who may otherwise go without. 

Gorman: It’s so different in every community. But we can play a huge role by scheduling time, outside of the practice, to visit each of these underserved communities where disparities are occurring—in efforts to narrow the gap. It’s especially important for breast surgeons and plastic surgeons to identify specifically where there’s an opportunity to make a difference in the community. We can help connect our patients to the social and financial resources available. We do this by participating as vendors at local community health fair events, educating patrons at local church congregations. We can also reach out to indigenous primary care health systems if physicians have referrals for recently diagnosed patients. So, we must let people know that—prior to and beyond a diagnosis—we are here and available to assist with getting them the best possible breast cancer treatment and services. Our goal is to meet their breast reconstruction needs as well.

Reconstructive Lumpectomy

Meade: A breast cancer diagnosis can be life-changing, and our goal is to ensure every woman faced with this journey has access to all the options and the leading-edge technology available. Reconstructive lumpectomy breast cancer surgery is one of the latest advancements in care that offers the unique benefit of pairing a lumpectomy and cosmetic reconstruction within one procedure using Hologic’s products. However, there is limited patient awareness that this option is available and that women don’t need to live with the cosmetic imperfections that may come with a traditional lumpectomy. We’re taking steps to increase conversations around this procedure and working to get the word out via our website Shape Her Future, so that more women know about the full spectrum of breast surgery options available to them.

Blackwood: We are very lucky to have some plastic surgeons who on many occasions donate their time, education, and surgery because the patient can’t afford to pay for treatment. This is very unusual and lucky for our patients to have those options available. It’s amazing just how dedicated the doctors and nurses in our RWJBH network are. The people are much more interested in making sure the patient is OK. In fact, I don’t remember the last time we discussed a breast cancer patient’s insurance status. My staff and I work hard to make sure patients can get the test and care they need, despite trying to get their healthcare insurance companies to do the right thing. Nothing is perfect in life. But I’ve been very impressed with the emotional, social, and financial resources RWJBH has surrounded our patients with and this type of care.

Cody: As physicians, we must continue to advocate for patients first and educate ourselves on existing healthcare disparities and their causes with an intent on equity. Patients cannot access what they do not know exists, and that is an important reason why education is so important to improving care.

At Crystal Clinic Plastic Surgeons, we realize the tremendous impact breast cancer has on the lives of our patients and their families. The Center for Breast Reconstruction is dedicated to helping patients restore their lives after breast cancer. Our comprehensive care starts at the time of diagnosis and lasts throughout survivorship. Our expert plastic surgeons have extensive training and experience in the most advanced forms of breast reconstruction.