Does Opioid Abuse Play A Role In Breast Cancer Deaths In Appalachia?

By Kelly Burch 10/31/18

One expert believes that opioid use disorder is connected to the high rates of breast cancer deaths in the region. 

woman holding breast cancer awareness ribbon

Women in Appalachia—especially West Virginia and Kentucky—have higher mortality rates from breast cancer than their counterparts around the country, and one researcher says that opioid abuse might be to blame. 

In an essay for The Conversation, Rajesh Balkrishnan, a professor of public health sciences at the University of Virginia, said that opioid abuse could be a factor in up to 60% of breast cancer deaths in the region. 

“Breast cancer death rates continue to remain abnormally high in the Appalachian region of the United States, and it’s partially due to a different epidemic in the U.S: opioid use," he writes. 

Long-term hormone treatments can be lifesaving for breast cancer patients, but using opioids to combat their side effects opens people up to another deadly disease: opioid use disorder. Cancer patients are often prescribed opioids for pain management, including the pain and fatigue that accompany hormone treatments.

“Although opioids are not considered first-line treatment for cancer-related pain, they are increasingly used to manage unbearable pain in breast cancer survivors,” Balkrishnan writes. “One thing that struck me when I looked at health insurance and cancer registry data was the extremely high and prolonged rate of use of dangerous medications like opioids in this population, sometimes as high as 50% in some areas.”

Balkrishnan’s team of researchers found that Appalachia has the most concentrated number of counties with exceptionally high opioid prescription rates—up to 65% above the national average.

This leaves people at risk for developing addiction, and can interfere with the long-term health of breast cancer patients, since many stop taking their hormone therapy medications when they become dependent on opioids, Balkrishnan believes. 

“The picture that emerges is indeed a grim one. We find many patients in Appalachia who undergo successful breast cancer treatment and then start life-prolonging hormone treatments along with opioids to manage side effects such as pain,” Balkrishnan writes.

“But many (over half in some counties) continue to remain on opioids, which are usually supposed to be prescribed only for the short term, and then discontinue long-term survivorship treatments such as hormones. The reasons these women discontinue traditional treatments is not completely clear, but my colleagues and I suspect it is related to people’s dependence on opioids.”

Appalachian women have the lowest breast cancer survival rates in the country. 

“It is heartbreaking to see a woman able to beat cancer, only to die because of sub-optimal use of a life-prolonging treatment or misuse of a short-term relief treatment such as opioids,” Balkrishnan writes.

“We need to work harder to educate and empower Appalachian breast cancer survivors about their treatment choices and decision-making that can be most beneficial to improving their life quality and quantity.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.