Abstract
Globally, over 2 million people are diagnosed with breast cancer each year, making it the most commonly diagnosed cancer in women. For early-stage breast cancer, a common treatment option is a lumpectomy, followed by radiation. Approximately 1.3 million lumpectomies are performed every year, which involves the surgical removal of a cancerous lump and its surrounding tissue. These procedures are generally successful; however, it can be difficult to properly address the void cavities left behind in the breast. Current options to address these deformities include autologous fat grafting and oncoplastic surgery, but each has its own drawbacks, such as the chance for cancer recurrence or longer surgeries, more expensive surgeries. As a result, my technical project focused on developing an injectable hydrogel system that promotes breast tissue regeneration. While this project addresses a biomedical need, its true impact depends on whether patients are able to access lumpectomies in the first place, which is shaped by social and structural factors that influence breast cancer diagnosis. The STS portion of my project aimed to examine how these factors determine who benefits from reconstructive technologies like the hydrogel system and how access itself is socially produced.
My technical research focused on developing an injectable hydrogel system to fill post-lumpectomy breast tissue voids and support tissue regeneration. The hydrogel system is made up of acrylated hyaluronic acid (AcHA) microgels and electrospun methacrylated hyaluronic acid (MeHA) nanofibers, creating a scaffold for native adipose cells, which are the key cells composing soft tissue, and supporting their adhesion and proliferation. While many current hydrogels employ ultraviolet (UV) light for crosslinking, this scaffold relies on a dual-crosslinking mechanism, undergoing physical assembly and chemical assembly through Michael addition. Through this process, covalent bonds form between the acrylate groups on the AcHA and the thiol groups from a PEG-SH crosslinker. Many clinicians are still cautious about using UV light due to perceived safety concerns, including the potential for DNA damage, making this crosslinking approach potentially safer and less damaging to tissue than UV-mediated methods. For injection, one syringe contains the PEG-SH crosslinker, and another contains the AcHA microgels, MeHA nanofibers, and GelB, which is used to induce porosity. The syringes are mixed using a luer-lock mechanism, and then injected, allowing for the material to conform to the irregularly shaped voids and then gel. The ultimate goal is to create a more clinically translatable and minimally invasive material for the treatment of post-lumpectomy voids that support tissue regeneration. Beyond breast reconstruction, this approach has the potential to be adapted for other soft tissue applications, which would expand the options for tissue reconstructive strategies.
In my STS research, I utilized the Social Construction of Technology (SCOT) framework to analyze how disparities in breast cancer diagnosis affect access to reconstructive treatment. My research demonstrated that patients, healthcare providers and facilities, and policymakers act as relevant social groups who all shape the timing of breast cancer detection. Patient-level factors, such as insurance status and screening frequency, influence delayed diagnosis timing, particularly among African American and low-income women, who are more likely to be diagnosed at later stages. Healthcare providers influence diagnostic timing through factors such as trust-building with patients and communication, which affects whether patients look for and follow through with care. Healthcare institutions determine the availability and quality of screening technologies, while policymakers and insurers play major roles in determining if someone is able to afford diagnostic services. All of these systems interact to shape when breast cancer is detected, resulting in unequal rates of early-stage diagnosis, which directly determines whether patients are eligible for a lumpectomy and resulting reconstructive options.
Together, the two components of this project demonstrate how biomedical innovation and healthcare equity are intertwined. The hydrogel system addresses the technical limitations of current post-lumpectomy reconstructive technologies by promoting natural tissue regeneration, but the STS analysis shows that access to these innovations depends heavily on what stage breast cancer patients receive their diagnosis, which is shaped by social systems rather than biology alone. Through the process of completing both projects, I learned that engineering solutions cannot be evaluated only by their technical performance, but also through their ability to work for everyone. Engineers hold the responsibility to not only consider what technologies can do, but also who is able to benefit from them and under what conditions. After all, what good is a new invention if it cannot benefit all who need it.
