Katherine
Reddy
Women managing breast cancer are at increased risk for sexual difficulties, such as vaginal dryness, pain during intercourse, and psychosocial challenges (e.g., anxiety), which can negatively impact their quality of life. These difficulties may be compounded by comorbid type 2 diabetes; blood glucose fluctuations can also contribute to sexual difficulties (e.g., vaginal dryness). Sexual difficulties may lead to avoidance of sexual activity, which may impact relationships, sexual well-being, and quality of life. We examined associations between sociodemographic, medical, and psychosocial factors and sexual avoidance among breast cancer survivors with type 2 diabetes. Breast cancer survivors (stage I-III disease) aged >21 with type 2 diabetes who had completed primary cancer treatment completed self-report measures of sociodemographic, medical, and psychosocial characteristics as well as sexual functioning and avoidance. Descriptive statistics were utilized to characterize the full sample and self-report measures. Only women who reported being married, partnered, or having a sexual partner were included in a regression analysis to examine the role of sociodemographic, medical, and psychosocial characteristics in explaining variance in sexual avoidance. Women (N=53) were M=64.46 years old and represented a variety of racial backgrounds (47.2% White, 37.7% Black, 11.3% American Indian/Alaskan Native, 3.8% Asian). 13.2% of the sample identified as Hispanic. 75.5% were married/partnered. 39.7% were diagnosed at stage II/III. 60.4% were post-menopausal. In a multiple linear regression analysis, Black race (versus other; β=0.230, p=.047), stressors (β=.463, p=<.001), and physical symptoms (β=.261, p=.039) each uniquely contributed to greater sexual avoidance. Identifying sexual difficulties and providing appropriate sexual health referrals (e.g., sex therapy, pelvic floor physical therapy) is an important component of breast cancer care. Our findings highlight the importance of supporting survivors to address chronic life stressors and physical symptoms that contribute to sexual avoidance and indicate that Black survivors may be more likely to experience sexual avoidance. Evaluating Public Awareness for Improved Diagnosis and Treatment of Rare Breast Cancers
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Authors:
Katherine Reddy
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Inflammatory breast cancer (IBC), a rare and NIH-designated cancer health disparity, is an aggressive subtype with a unique presentation that often delays diagnosis and treatment. Reproductive risk factors, higher incidence rates among marginalized populations, and social drivers of health (SDoH) limit healthcare access, making IBC an important focus for mitigating health disparities. Previous research with primary care providers (PCPs) and IBC patients underscored the need to assess IBC awareness among members of the general public, leading to the focus on evaluating the public's knowledge and health-seeking behaviors related to IBC and other rare breast cancers. Surveys for PCPs, patients, and the public were developed with guidance from a Community Advisory Board and refined through cognitive interviews. PCPs and IBC patients were identified from North Carolina medical centers and community practices. Public participants were recruited via email, social media, and direct outreach at urban and rural clinics serving low-income, medically complex patients, as well as diverse community events. Data were analyzed using descriptive statistics and t-tests (p<0.05). Among public participants (n=170; 77% Female, 55% White, 21% Black, 12% Asian, 9% Hispanic, 7% American Indian/Alaskan Native, 4% Pacific Islander, 61% ages 25-44, 43% with household incomes <$99,000, 41% based in North Carolina), 20% had never heard of IBC (p<0.0001). Misconceptions included: 70% incorrectly identifying breast lumps as a symptom (p<0.0001); 40% not recognizing overweight status as a risk factor (p=0.009); 36% not identifying the characteristic "pitted" skin appearance (p=0.0003); and 35% not recognizing changes in breast size/shape as a symptom (p=0.0001). Healthcare-seeking barriers included fear of diagnosis, difficulty discussing symptoms, lack of insurance, transportation, and religious concerns. Encouragingly, 97% of participants were willing to share IBC information, particularly with family and friends (p <0.0001). Most supported integrating visual aids and educational materials into survey administration. Findings highlight the need for public education alongside provider- and patient-focused research to reduce the health disparities associated with rare cancers. Addressing modifiable SDoH in diverse communities is critical to improving early detection and management of IBC and other rare cancers in primary care.
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Duke University / 2025
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Co-authors:
Katherine Reddy