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Ending Racism in Medicine

May 23, 2001

In a speech to academic researchers and healthcare executives, Dr. Rodney Hood, president of the National Medical Association (NMA) called on the medical community to focus more aggressively on the persistent gap in quality of care faced by the nation’s minorities.

The NMA, which represents more than 25,000 African-American physicians, has been a consistent voice in the call for more parity in care for minority groups in the U.S.

Hood noted that each year 35 percent more African Americans die from cancer than the general population, and 40 percent more die from heart disease. "Nobody is talking about these excess deaths," he said. "Little effort has been made to address these disparities through organizational quality improvement."

Recently, the American Cancer Society (ACS) released findings indicating that general cancer incidence rates are finally falling among African-Americans. But they are still dying from their disease at unacceptably higher rates.

For the first time in 20 years, the incidence of newly diagnosed cancers among African Americans fell, as measured during the period 1993 – 1997. Similarly, the cancer mortality rate fell during the period 1991 – 1997, reversing a 30-year trend.

However, despite this progress, the ACS said, "African-American women continue to have a higher death rate from breast cancer than Caucasian women, despite lower breast cancer incidence rates." Overall, the cancer death rate for African-American women was 22 percent higher than that for Caucasian women.

And yet, numerous studies have shown that if African-American patients are diagnosed at a similar stage of disease—and given similar treatment opportunities—differences in recurrence and mortality rates effectively disappear.

For example, a study published in the journal CA - A Cancer Journal for Clinicians concluded that African-American breast cancer patients had similar outcomes to white patients when their treatment and follow-up care were equal and appropriate for their disease conditions.

According to the lead author, Dr. James Dignam of the University of Pittsburgh, the reason for the increased mortality rates for African-American breast cancer patients compared to their Caucasian counterparts must therefore lie beyond simple biological differences between the races.

What causes for the disparity did Dignam identify? He suggested the fact that cancer was discovered late was a prime factor in less favorable outcomes. And this delay was due to less access to or utilization of health care resources that would result in earlier detection.

Dignam’s study showed that African-American women were often first seen by doctors with larger tumors, greater nodal involvement, and estrogen receptor negative tumors. Even obesity, found in demographic studies to be more prevalent among African-American breast cancer patients, was associated with a more advanced stage of the disease. This was possibly due to obesity’s effect on estrogen, which can accelerate disease progression.

Dignam further noted that studies in some urban hospitals, which are likely to treat a disproportionate share of African-American breast cancer patients, have a greater rate of late-stage diagnosis as well as a higher degree of non-standard care. This included less frequent radiation therapy after surgery, fewer diagnostic tests to determine the best therapy, and lower use of more aggressive chemotherapy and/or tamoxifen.

In addition, Dignam cited studies in which African-American women were much more likely to have received total mastectomy rather than lumpectomy with radiation therapy in cases where either procedure would have been acceptable.

SOURCES:

National Medical Association (http://www.nmanet.org)

CA – A Cancer Journal, Jan/Feb 2000; 50:50-64

The American Cancer Society (http://www.cancer.org)

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