racial disparities


U.S. Breast Cancer Deaths Falling Steadily — But Black Women Increasingly At Risk

Breast cancer is becoming an ever more-survivable disease, but there's bad news for African-Americans. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

Breast cancer is becoming an ever more-survivable disease, but there’s bad news for African-Americans. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

By Richard Knox

With all the recent controversy over how often women should get mammograms, you might not realize that breast cancer is becoming an ever more-survivable disease.

But, alas, that’s not the case among black women in this country. Historically they’ve had the highest risk of dying if they get breast cancer among any ethnic group. And now, data from the American Cancer Society show that African-Americans have nearly caught up with whites over the past three years in their risk of getting breast cancer in the first place.

Given black women’s higher risk of dying from breast cancer, that’s particularly bad news.

Breast cancer accounts for one in every three malignancies among U.S. women — it’s the most common type if you don’t count non-melanoma skin cancers, which are usually inconsequential. More than 230,000 American women will get a breast cancer diagnosis this year, and about 40,000 will die of the disease.

But over the past 26 years, the overall U.S. breast cancer death rate has dropped by more than a third, according to recent research. That’s nearly a quarter-million living women who would have died from breast cancer at rates that prevailed among their mothers’ generation.

“Whether people realize it or not, breast cancer mortality rates have been dropping since about 1990,” says Carol DeSantis of the American Cancer Society, lead author of an update on the disease published Thursday in CA: A Cancer Journal for Clinicians.

Part of that success is due to widespread mammograms, which can find breast cancers at an early stage, although the contribution of regular mammogram screening is unclear.

“Screening has clearly contributed to lowering mortality, but we can’t say by how much,” DeSantis says.

Better treatments are clearly a big part of this success story — more effective chemotherapy, the estrogen-blocking drug tamoxifen, and drugs targeted at the protein HER2 and other growth promoters on the surface of some women’s breast cancer cells.

Put it together with our aging society — more women reaching the most breast cancer-prone years, and fewer women dying of the disease — and the result is record numbers of breast cancer survivors.

More than 3.1 million American women with a history of breast cancer are alive today, and the great majority of them are cancer-free, DeSantis says.

The number of survivors will reach 4 million within the coming decade.

But a closer look at the numbers shows that not all women are benefiting equally. Continue reading


Study: Black Men With Prostate Cancer More Likely To Get Worse Care Than White Men

A new study of men 65 or older with localized prostate cancer shows that black men may receive poorer care than white men in treatment for prostate cancer. (M. Spencer Green/AP)

A new study of men 65 or older with localized prostate cancer shows that black men may receive poorer care than white men in treatment for prostate cancer. (M. Spencer Green/AP)

Imagine you’re a 70-year-old black man with prostate cancer. Here’s what a new study reveals about your outlook:

You’re far more likely to get worse medical care than your white counterparts, including more time waiting for your surgery and more emergency room visits and hospital readmissions after surgery. You’ll also likely spend more money on your care. Oddly, though, that inferior care won’t necessarily translate into a worse chance of survival.

The study, published online by JAMA Oncology, specifically looked at a group of men on Medicare with localized prostate cancer. The standard of care for such patients involves either removal of the prostate gland (called a radical prostatectomy or RP), radiation therapy, a combination of the two, or active surveillance (close followup of patients).

Prostate cancer is one of the most frequently diagnosed cancers among men in the U.S., with estimates of about 220,800 new cases in 2015 and approximately 27,540 deaths.

Researchers analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER)-Medicare database for 26,482 men 65 or older with localized prostate cancer who underwent radical prostatectomy. The patients included 2,020 black men (7.6 percent) and 24,462 non-Hispanic white men (92.4 percent).

Some key findings:

59.4 percent of black men underwent RP within 90 days vs. 69.5 percent of white men.

Black men had a seven-day treatment delay compared with white men in the top 50 percent of patients.

Black men were less likely to undergo lymph node dissection.

Black men were more likely to have postoperative visits to the emergency department or be readmitted to the hospital compared with white men.

The top 50 percent of black patients had higher incremental annual costs for surgery, spending $1,185 more compared to white patients.

I asked the study’s lead researcher, Quoc-Dien Trinh, M.D., of Brigham and Women’s Hospital in Boston and Harvard Medical School, to further explain the findings. Here, edited, is our conversation:

Rachel Zimmerman: What are the most extreme examples of disparities you found between black men and white men treated for prostate cancer?

Quoc-Dien Trinh: Blacks were 35 percent less likely to undergo surgery with 3 months of diagnosis; Blacks were 45-48 percent more likely to require a visit to the emergency department after surgery; Blacks were 28 percent more likely to be readmitted after surgery; Blacks were 24 percent less likely to undergo a lymph node dissection at prostatectomy.

How do you account for these dramatic differences in care?

It is possible that blacks are not receiving their care at the best institutions and/or with the best providers. Continue reading

White Coats For Black Lives: Toward Racial Equality In Health Care

Kaitlyn Veto/flickr

Kaitlyn Veto/flickr

Acknowledging the public health impact of racism and deep disparities in the quality and accessibility of medical care for patients of color, a national organization, White Coats for Black Lives, says it’s launching a new effort today, in celebration of Martin Luther King, Jr.

Dorothy Charles, one of the group’s organizers and a first year medical student at the University of Pennsylvania’s Perelman School of Medicine, offers some context in an email:

Racism profoundly impacts people of color: the black-white mortality gap in 2002, for example, accounted for 83,570 excess deaths. As future physicians, we are responsible for addressing the perpetuation of racism by medical institutions and seek policy change to eliminate disparities in outcomes.

Here’s a statement from the White Coats for Black Lives National Steering Committee:

Upon matriculating in medical school, students recite the Hippocratic Oath, declaring their commitment to promoting the health and well-being of their communities. On December 10, 2014, students from over 80 medical schools across the United States acted in the spirit of that oath as we participated in a “die in” to protest racism and police brutality. In our action, we called attention to grim facts about the public health consequences of racism, acknowledged the complicity of the medical profession in sustaining racial inequality, and challenged a system of medical care that denies necessary treatment to patients unable to pay for it, disproportionately patients of color.

Today, in celebration of the legacy of Dr. Martin Luther King Jr., we announce the founding of a national medical student organization, White Coats for Black Lives. This organization brings together medical students from across the country to pursue three primary goals:

1. To eliminate racism as a public health hazard

Racism has a devastating impact on the health and well-being of people of color. Tremendous disparities in housing, education, and job opportunities cut short the average Black life by four years. Physicians, physician organizations, and medical institutions must therefore publicly recognize and fight against the significant adverse effects of racism on public health. We additionally advocate for increased funding and promotion of research on the health effects of racism.

2. To end racial discrimination in medical care

We recognize that insurance status serves in our healthcare system as a “colorblind” means of racial discrimination. While it is illegal to turn patients away from a hospital or practice because of their race, patients across the country are frequently denied care because they have public insurance or lack health insurance. We support the creation of a single payer national health insurance system that would give all Americans equal access to the healthcare they need. Such a system would create a payment structure that reflects the fact that “Black lives matter.” Moreover, ample evidence suggests that patients of color receive inferior care even when they are able to see a doctor or nurse; we therefore advocate for the allocation of funding for research on unconscious bias and racism in the delivery of medical care. Continue reading

Caution: ‘Acceptable’ Black Women’s Hairstyles May Harm Health

(U.S. Army)

(U.S. Army)

This spring, the Pentagon issued Army Regulation 670-1, which included bans on several hairstyles worn mainly by black women, including twists and multiple braids. After a major backlash that included accusations of racial bias, that grooming policy is now under review. Here, researchers at the Connors Center for Women’s Health at Brigham and Women’s Hospital argue that this is more than an issue of racial fairness; it could also cause harm to women’s health — and disproportionately impact black women, whose life expectancy is already five years less than white women’s.

By Tamarra James-Todd and Therese Fitzgerald
Guest contributors

We are encouraged by the news that the Pentagon is reviewing the Army’s grooming policy, Army Regulation 670-1, which many deemed to be racially biased because it banned hairstyles worn primarily by black women.

Such policies set unreasonable standards for what is appropriate or acceptable in our society, and promote the idea that natural “black” hair is somehow inappropriate and unacceptable.

But perhaps most disturbing is the growing evidence that the process involved in straightening curly hair and maintaining acceptable hairstyles is harmful to women’s health, disproportionately affecting black women and making the pervasive practice of banning “black” hair styles a major health equity issue.

Nearly half of black women and girls use hair products that contain endocrine-disrupting chemicals compared to just 8 percent of whites.

The military’s previous position on this reflects a precedent that unfortunately continues to exist in corporate and private sector settings throughout the country. Labeled as “grooming” issues, companies have fired employees for wearing dreadlocks and a private school in Orlando, Florida, threatened to expel a young girl if she refused to straighten or cut her natural black hair.

The public discourse around these biased policies should not only focus on the racism they perpetuate but also on the potential harmful health outcomes and health disparities they may leave in their wake now and for future generations.

In order to conform to the standards of appearance that these policies demand, black women and girls are often encouraged to straighten or otherwise change the texture of their natural “black” hair. Unfortunately, many of the hair relaxers, oils, creams and other products used to straighten or alter curly hair contain synthetic chemicals that disrupt the normal functioning of the human body’s endocrine system, which regulates and secretes hormones.

Based on hair product labels, nearly half (49 percent) of black women and girls use hair products that contain endocrine-disrupting chemicals compared to just 8 percent of whites, which could leave blacks with higher levels of these chemicals in their bodies compared to whites.

For example, phthalates, a class of endocrine-disrupting chemicals used in hair products, are known to be found at higher levels in blacks than whites. Research led by Dr. Tamarra James-Todd at the Connors Center for Women’s Health at Brigham and Women’s Hospital has revealed that higher phthalate levels are associated with a variety of poor health outcomes that disproportionately impact black women and girls including:

Type 2 diabetes, a condition twice as common among black women compared to white women, as well as insulin resistance and other associated conditions. Continue reading

Medical Segregation: Most Minority Patients See Minority Doctors

A Hispanic couple consult with an Asian doctor (National Cancer Institute via Wikimedia Commons)

A Hispanic couple consult with an Asian doctor (National Cancer Institute via Wikimedia Commons)

A paper just out in the journal JAMA Internal Medicine finds a striking state of segregation in American medicine: “Nonwhite physicians cared for 53.5% of minority and 70.4% of non–English-speaking patients,” sums up the study, which was led by Cambridge Health Alliance doctors.

And that racial-ethnic split has changed little since a similar look a quarter-century ago, the paper notes.

As Obamacare kicks in, the rolls of the newly insured are expected to include many members of minorities and recent immigrants. Those newly covered people are expected to boost the demand for doctors, particularly in primary care. But will they be able to get access to care?

From the press release:

“There is a lot of concern that there will not be enough physicians willing and able to care for them,” said Danny McCormick, MD, MPH, the study’s senior author, a physician at Cambridge Health Alliance, and an associate professor of medicine at Harvard Medical School. “In order to increase the number of Black and Hispanic physicians, medical schools will need to more fully consider the physician workforce needs of the health care system as a whole in admissions decisions.”

An accompanying commentary in JAMA Internal Medicine calls for medical schools to admit more minority applicants, even if some of their science and other academic scores are lower, because minority physicians show more commitment to serving poor and minority populations.

The study’s lead author, Dr. Lyndonna Marrast, argues similarly: “Medical schools need to redouble their efforts to recruit and train minority students,” she said, “and we need policies at both the federal and institutional levels on a much larger scale than what we have now.”

These efforts to train more minority doctors would be “stopgap measures,” she said, because “ideally, we would live in integrated neighborhoods and everyone would have equal access to health care. Instead, we have members of society who are from marginalized groups, often geographically and culturally isolated, and they have a hard time accessing health care.”

How about getting more white doctors to serve more minorities? Continue reading

Why We Need More Minority Doctors

Updated at 1:23 PM, February 10, 2012

Dr. Alden Landry

Dr. Alden Landry

“I’m an ER physician,” Dr. Alden Landry told me. “When I walk into patients’ rooms and start speaking to them and introduce myself as their doctor, often older black women will say, ‘Thank you for being my doctor! I’m so proud of you. I’m glad you’re going to be taking care of me.’ They say they feel more comfortable with me as their physician.”

Dr. Alden Landry practices emergency medicine at Beth Israel Deaconess Medical Center, but he’s more than just a doctor — he’s helping lead the movement to diversify medicine. He heads up projects on the issue at Beth IsraelMassachusetts General Hospital, and Harvard Medical School

“It’s not always a rosy picture talking to my patients,” he explained. “Early in my career, there was a patient — an older black man — [who] had been in the emergency department for a number of hours, and they’d placed him in the hallway to wait. I went over to talk to him and ask him if he needed anything. ‘Why do they always put the black patients in the hallway?’ he asked me.” I can’t necessarily say he was placed there because of his race – but when you hear comments like that, it shows that patients don’t feel appreciated when they’re receiving medical care, that they feel like second- or even third-class citizens, that their concerns are being overlooked.”

Dr. Landry, among many in the medical field, feels there’s a way to help solve this problem: recruit more African-Americans and Hispanics to be doctors. That’s why he’s heading up the Tour for Diversity as its co-director. The tour is a new initiative funded by the Aetna Foundation — and, yes, it is an actual tour. Continue reading

‘Health Of Boston’ Mixes Good News And Bad: Teen Births Down, Racial Gaps Loom

This just in from the Boston Public Health Commission: The new “Health of Boston report is out, and mixes the good news with the bad:

Fewer Boston teens are having babies, fewer Boston public high school students are smoking, and fewer city children have elevated blood lead levels, according to the 2011 Health of Boston report released today by Mayor Thomas M. Menino.

But amid the good news about the health of Boston residents in the 398-page report prepared by the Boston Public Health Commission were troubling signs that racial disparities persist. In 2009, the asthma hospitalization rate for black children ages 3 to 5 was four times the rate for white children; the tuberculosis rate for Asians was three times the rate for Boston residents overall; and the heart disease hospitalization rate for Latino males was more than twice the rate for white males. In 2010, a higher percentage of black and Latino adult residents were obese compared to white and Asian adult residents, while a higher percentage of adult smokers were white compared to other racial and ethnic groups.

“The Health of Boston report is always a sobering reminder that our work is far from finished, though every year we continue to see areas of progress,’’ Mayor Menino said. “This report will help us set our public health priorities so that we align resources where they are most needed.’’

Among the bright spots for Boston residents: Continue reading

10 Things About ObamaCare You May Not Know But Should

Harvard professor and author John E. McDonough

Let us be clear. John McDonough is a Democrat down to his DNA. Though he’s a professor at the Harvard School of Public Health, he makes no pretense of being dispassionate about the Affordable Care Act of 2010, better known as ObamaCare. He calls it a landmark of the magnitude of the creation of Social Security or Medicare.

John also knows the law inside and out, and shares his knowledge — both of what’s in the 18-month-old law and how it politically came to be — in a new book, “Inside National Health Reform.” Thankfully, he’s a great sport about turning esoteric knowledge into soundbites. On Friday, he took our “3-minute challenge” here, and below, he offers the top 10 things people probably don’t know about ObamaCare but should:

1. 32 million newly covered
Beginning in 2014, an estimated 32 million people who today are uninsured will begin to be enrolled in affordable coverage. About 16 million will be enrolled through expansions of Medicaid, and 16 million through insurance “exchanges.” That will leave about 23 million uninsured.

Who are those 23 million? The Urban Institute estimates about 40% of them will be eligible for Medicaid and just not sign up. We’d like those people to get signed up but the truth is, if they get sick and get health care, the clinic or hospital will be able to — or in fact, be required — to sign them up on the spot.

‘If it gets repealed, which could happen depending on what happens on Nov. 6, 2012, it will be a couple of generations before our federal government may find the political will to go at this again in such a significant way.’

So then about a quarter of them are undocumented, and the rest include some — like about 30,000 in Massachusetts — who say, ‘I’m going to pay the penalty and not get covered.’

2. It’s not really a ‘mandate’

The individual mandate is not really a mandate; it is a financial penalty if you can afford to buy health insurance and don’t do so. Switzerland actually has a real mandate — the law requires you to buy health insurance and the government will make you buy it — versus what we have in Massachusetts and the Affordable Care Act, which is just a financial penalty for not purchasing coverage if you can afford to do so.

3. It’s projected to lower the deficit

According to the Congressional Budget Office, the law, over 10 years, is fully paid for and is estimated to lower the federal budget deficit by over $70 billion.

The costs are more than compensated for by new taxes, savings in the system and other revenue enhancements. Continue reading

Multiple Babies, Not Breastfed: Link To Aggressive Cancer In African-Americans

This just in from Boston University:


(Boston) – Investigators from the Boston University’s Slone Epidemiology Center have reported findings that may shed light on why African American women have a disproportionately higher risk of developing more aggressive and difficult-to-treat breast cancers, specifically estrogen and progesterone receptor negative (ER-/PR-) cancers.

The study, which appears online in Cancer Epidemiology, Biomarkers & Prevention, found that high parity (giving birth to two or more children) was associated with an increased risk of ER-/PR- cancer, but only among women who had not breastfed.

The findings were based on the ongoing Black Women’s Health Study, which has followed 59,000 African American women by biennial questionnaire since 1995.

In 14 years of follow-up, 318 women developed breast cancers negative for estrogen and progesterone receptors (ER-/PR-), while 457 developed breast cancers with estrogen and progesterone receptors (ER+/PR+). Giving birth to two or more children was associated with a 50 percent increase in the incidence of ER-/PR- breast cancer, but the association was not present among women who had breastfed.

The release also quotes researcher Julie Palmer:

“Our results, taken together with recent results from studies of triple negative and basal-like breast cancer, suggest that breastfeeding can reduce risk of developing the aggressive, difficult-to-treat breast cancers that disproportionately affect African American women,” she said.

Why An Emergency Medic Might Ask About Your Race

In his column yesterday, The Boston Herald’s Howie Carr makes it sound like Massachusetts medics are so busy these days filling out forms about their patients’ race that they may ignore the medical emergency at hand.

Howie’s rants are often enjoyable to read for their inflamed wrath, but this one struck me as so oddly lopsided that I asked the Department of Public Health what was up. Howie included just this from the Department of Public Health statement: “Patient health and safety must always be an EMT’s highest priority. Collecting this information must not delay nor prevent patient assessment or the provision of care.”

Here’s the whole statement, which makes clear that this sort of collection of patient data is a national norm, not a PC liberal plot:

Patient health and safety must always be an EMT’s highest priority. Collecting this information must not delay nor prevent patient assessment or the provision of care. State regulations (105 CMR 170.347) require EMTs to collect a variety of background information from patients, including their name, address, age, race and ethnicity, past health history, and medications that they are currently taking. Of course, if a person objects to responding, they have the option not to respond.

For years, more than 25 states — representing every region of the country — have been collecting this data and submitting it to the National EMS Information System (NEMSIS), and the other 25 states have committed to doing so.

NEMSIS is funded by the U.S. National Highway Transportation Safety Administration (NHTSA) in order to standardize collection of EMS data by creating a uniform data set that is used to compare and assess the quality of provision of EMS across the country. Similar data is collected in other areas of the health care system, such as hospitals and nursing homes. The NEMSIS system will catch the EMS sector up to the rest of health care in terms of having data-driven assessment available, and provide a valid way for looking at what EMS is doing, what are patient outcomes, and how EMS can be improved. Massachusetts is in the early stages of data collection and has not yet begun submitting data to NEMSIS.

Clearly, collecting data on race is a way of detecting disparities in how patients of different races are treated. Howie writes: “This is about a sick obsession by the liberals with somehow proving “disparities,” which there certainly are in this country, only they’re exactly the reverse of what the moonbats would have you believe they are.”

In actual fact, the data on disparities suggest that they’re not only real, they’re deeper than many of us might suspect. Here’s a post of ours on a national Massachusetts General Hospital study that found black and Hispanic patients were treated differently for chest pain. And here’s an overview of racial disparities in health from the CDC, an institution not generally considered a bastion of political correctness.