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Int J Surg
Int J Surg
JS9
International Journal of Surgery (London, England)
1743-9191
1743-9159
Lippincott Williams & Wilkins Hagerstown, MD

IJS-D-24-01985
10.1097/JS9.0000000000001721
00104
3
Correspondence
Letter to the Editor: ‘Advancing breast cancer care: a three-tiered strategy with social workers at all levels to address ethnic disparities’
Li Hui MD *chipperli@163.com

Zhang Tiantian MM 870348111@qq.com

Guo Chengshan MD guochengshan1@163.com

Department of Rheumatology and Immunology, The Second Affiliated Hospital of Shenzhen University, The People’s Hospital of Baoan Shenzhen, Shenzhen, Guangdong, People’s Republic of China
* Corresponding author. Address: Department of Rheumatology and Immunology, The Second Affiliated Hospital of Shenzhen University, The People’s Hospital of Baoan Shenzhen, 118 Longjing 2nd Road, Shenzhen, Guangdong 518100, People’s Republic of China. Tel.: +86 185 658 70539. E-mail: chipperli@163.com (H. Li).
9 2024
28 5 2024
110 9 59515952
11 5 2024
19 5 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

OPEN-ACCESSTRUE
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pmc Dear Editor,

We have read with great interest the article titled ‘Higher disease burden and lower utilization in Mongolian with breast cancer: a 9-year retrospective cohort study of 18.19 million adults in China’ by Chen et al.1. This study offers valuable insights into the ethnic disparities in breast cancer burden and healthcare utilization between Mongolian and Han women in Inner Mongolia, China. While the findings are compelling, we propose future research to explore more targeted directions and outline a three-tiered management strategy for advancing care, underscoring the essential role of social workers at three levels.

Considering the substantial advancements in medical technology, socioeconomic conditions, and public health policies from 2012 to 2020, it is important to note that such factors were not taken seriously into account in the study. For instance, several epidemics such as COVID-19 occurred in the past years, which might have led to disruptions of medical services, redistribution of healthcare resources, the extra psychological and economic burden on patients, or delays in data collection and reporting. Future research could use methods such as segmented time analysis, mixed-effects models, and time-series analysis to address these temporal changes and their impacts on the study’s conclusions2.

The study meticulously adjusted for confounders including age and stage at diagnosis, gross domestic product (GDP) level of residence, alcohol consumption rate, smoking rate, Charlson Comorbidity Index, medical insurance, education level, and all treatments using stratified Cox models. However, I advocate for the inclusion of additional pertinent factors such as environmental exposures, family health history, mental health status, and proximity to healthcare facilities in future studies to better tailor interventions for diverse patient groups3,4.

The authors’ approach to distinguishing varying risks across different GDP levels of residence, age at diagnosis, types of medical insurance, and education levels is commendable. Given the distinct clinical and therapeutic responses to various types of breast cancer, we recommend conducting detailed subgroup analyses by stage, pathological types (e.g. invasive ductal carcinoma, invasive lobular carcinoma, mixed ductal/lobular carcinoma), and hormone receptor status [e.g. estrogen receptor (ER)-positive/negative, human epidermal growth factor receptor 2 (HER2)-positive/negative]3. Such analyses would enable a more precise evaluation of the burden and outcomes for patients across different clinical categories and enhance the identification of groups with specific needs or varying responses to treatments.

The authors proposed several valuable strategies to address health disparities among minority populations, including improving health literacy, reforming the health insurance system, and implementing screening programs. However, these recommendations are somewhat general. Expanding upon the more comprehensive analysis, we support the development of a three-tiered management strategy to address the identified disparities in breast cancer burden and healthcare utilization among Mongolian women.

The initial level should focus on the general population with educational campaigns to enhance health literacy, emphasizing breast cancer risks, symptoms, and early detection through culturally tailored outreach. The intermediate level should target high-risk women, offering regular screenings, genetic counseling, and access to affordable diagnostics alongside lifestyle modification programs to address risk factors like obesity and diabetes. The most intensive level should support diagnosed patients through a collaborative effort among healthcare providers, specialists, social workers, and families, ensuring coordinated treatment, advanced care, and psychosocial support, aligning with best practices for comprehensive cancer care.

Notably, social workers play a critical bridging role in implementing these strategies across three levels5. At the individual level, they provide personalized support, counseling, and resources to help patients navigate the healthcare system, manage treatment side effects, and access financial aid. At the community level, they organize educational workshops, facilitate support networks, and advocate for culturally sensitive healthcare services. At the systemic level, they collaborate with healthcare providers and policymakers to advocate for policy changes that enhance healthcare access and quality, address social determinants of health, and reduce disparities, ensuring that the healthcare system is responsive to the needs of minority populations.

In conclusion, the proposed three-tiered strategy, with social workers playing a pivotal role at 3 levels, aims to create a more equitable healthcare environment. This approach enhances outcomes for Mongolian women with breast cancer and serves as a potential model for addressing health disparities in other minority groups.

Ethical approval

Not applicable.

Source of funding

This work was supported by the Medical and Health Research Project of Baoan District (No. 2023JD250) and the Key Specialties in Clinical Medicine of the People’s Hospital of Baoan Shenzhen (No. 8).

Author contribution

This ‘Letter to the Editor’ is prepared and authored by Hui Li, Tiantian Zhang, and Chengshan Guo.

Conflicts of interest disclosure

There are no conflicts of interest.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Hui Li.

Data availability statement

No data was used in this ‘Letter to the Editor’.

Provenance and peer review

Commentary, internally reviewed.

Acknowledgements

Not applicable.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 28 May 2024
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References

1 Chen J Qiao L Qi M . Higher disease burden and lower utilization in Mongolian with breast cancer: a 9-year retrospective cohort study of 18.19 million adults in China. Int J Surg 2024. doi:10.1097/JS9.0000000000001478 . [Epub ahead of print].
2 Morgan OW Griffiths C Majeed A . Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med 2007;4 :e105.17407385
3 Loibl S Poortmans P Morrow M . Breast cancer. Lancet 2021;397 :1750–1769.33812473
4 Atalay K Edwards R Georgiakakis F . Mortality inequality, spatial differences and health care access. Health Econ 2023;32 :2632–2654.37507349
5 Taylor SH Roberts RW . Theory and Practice of Community Social Work. Columbia University Press; 1985.
