Medical Education May Improve Care for Breast Cancer Minority Populations

Following the publication of her study showing various gaps and racial disparities associated with guideline-concordant care receipt for inflammatory breast cancer (IBC), Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, FACS, spoke with CancerNetwork^® about potential institutional solutions for mitigating these health inequities.

According to Fayanju, clinicians may systematically underdiagnose IBC in racial minority populations due to a potential inability to recognize erythema and similar symptoms in patients with darker skin tones. She consequently emphasized greater medical education for primary care providers, surgical oncologists, and other clinicians to recognize how different populations may present with IBC while employing written and photographic documentation for those with suspected abnormalities, thereby ensuring more accurate diagnoses and treatment strategies upfront.

Fayanju is the Helen O. Dickens Presidential Associate Professor, chief in the Division of Breast Surgery at Penn Medicine, surgical director of Rena Rowan Breast Center, director of Health Equity Innovation at Penn Center for Cancer Care Innovation (PC3I), and senior fellow at Leonard Davis Institute of Health Economics (LDI), Perelman School of Medicine at the University of Pennsylvania.

Transcript:

In IBC, there’s a concern that it is systematically underdiagnosed or delayed in its diagnosis in people with darker skin because people may not recognize the classic signs of erythema and peau d’orange in people who have black and brown skin. It’s going to be really important to continue with medical education. That means that primary care providers, obstetrics and gynecology [OB/GYN oncologists], as well as oncologists and surgeons, are not treating something that’s inflammatory as an infection or some type of lymphedema; [it means] that they recognize it to be IBC and act accordingly.

I believe, a lot, in picture documentation. If you suspect it, actually taking a picture and putting it in a chart allows for an objective comparison from visit to visit, for someone who might be suspected to have abnormality. That way, we can be surer about IBC diagnoses upfront and treat them appropriately vs treating them like a locally advanced cancer that may not receive the same sequence of guideline concordant care that I already described. As I said, [there needs to be] education of of physicians as well as of surgeons and medical oncologists to recognize what IBC looks like in diverse individuals, [and] standard documentation, photographic as well as written, of symptoms that are consistent with IBC so we can track people and treat them appropriately.

Then, [providers must] understand the context in which patients receive treatment. I’m a researcher who looks at social determinants of health, and I’m also very interested in the ways in which patients receive care and engage in shared decision-making. [Providers should] make sure that patients understand why we’re proposing certain treatment regimens, why the sequence of treatment matters, and then anticipate any barriers to treatment receipt that might arise as a result of patients’ circumstances, their feelings towards the medical industry, or the ways in which we deliver information about care that may not be well received and may cause them to forego life-saving treatment.

Reference

Tadros A, Diskin B, Sevilimedu V, et al. Trends in guideline-concordant care for inflammatory breast cancer. JAMA Netw Open. 2025;8(2):e2454506. doi:10.1001/jamanetworkopen.2024.54506