Cancer Screening Recommendations Put Nonwhite Women at Risk
In the United States, the recommended age for women to begin routine mammograms for cancer screening was recently increased to 50 years of age. This was based on a study of 747,763 mostly white women showing that breast cancer diagnoses peaked in their 60s. But researchers from Massachusetts General Hospital (MGH) have published a new study in JAMA Surgery that shows black, Hispanic, and Asian women tend to get breast cancer earlier than white women. A lack of data from racially diverse populations could put nonwhite women at risk for delayed diagnosis. According to David Chang, PhD, MBA, MPH, of the MGH department of surgery and an associate professor of surgery at Harvard Medical School, "The situation with breast cancer is one of the best examples of how science done without regard to racial differences can produce guidelines that would be ultimately harmful to minority patients."
From the study:
The US Preventive Services Task Force (USPSTF) currently recommends initiating breast cancer screening at 50 years of age in patients at average risk. However, we hypothesize that these guidelines may not be sensitive to racial differences and may be inappropriately extrapolating data from largely white populations for use in racially diverse populations. This process could result in underscreening of nonwhite female patients. These concerns are similar to broader discussions regarding sex bias in the clinical research process, leading to recent policy changes at the National Institutes of Health and the US Food and Drug Administration.
Opioid Crisis Rising in Black Communities
The opioid crisis began in white, rural communities, but it is a growing problem in black, urban communities, where the death rate from opioid use is higher. "It's a frightening time," says Dr. Edwin Chapman, who specializes in drug addiction in Washington, D.C., "because the urban African-American community is dying now at a faster rate than the epidemic in the suburbs and rural areas." White opioid abuse typically centers on prescription drugs like OxyContin. Black patients tend to be prescribed less pain medications, which may have spared them from the initial crisis. But now, black communities are falling victim to fentanyl, a synthetic opioid that is often laced in heroin and other street drugs.
From the article:
One of the challenges [of treating this epidemic] is debunking myths—"this is a chronic disease and not a moral failing," [Dr. Edwin Chapman] says, noting that science shows drug addiction is a brain disorder and some are more predisposed to it than others.
Chapman is soft-spoken, but his determination to fight this current drug crisis in his community is unwavering. He has partnered with several groups, including Howard University and the Johns Hopkins Urban Health Institute, to share information and raise awareness. Fighting stigma is a big part of the battle against this epidemic, he says.
"Seventy-eight percent of the overdoses in the district are African-Americans," says Chapman. "It's just that the population has been totally ignored. They are invisible."
Medical Students in Puerto Rico Suffer Effects from Hurricane Maria
A viewpoint published in JAMA Internal Medicine explains the impediments to medical education in Puerto Rico following the destruction of Hurricane Maria, including depleted funds for education, disruptions to rotations, and lack of electricity. Students enrolled in Puerto Rican medical schools account for nearly a quarter of all Latino medical students in the US. Therefore, obstacles to their education could dramatically impact the diversity of physicians on the mainland.
From the article:
The authors issue a call to action, requesting a change to the clinical rotation system and a call for residency programs to receive strong guidance regarding consideration of medical students in Puerto Rico. These recommendations are followed by provocative questions about the inherent responsibility of unaffected medical schools to assist those programs who are in need.
Health Affairs Devotes Issue to Health Equity
The March issue of Health Affairs is devoted to advancing health equity. It features articles describing various approaches and programs designed to reduce inequity, including an unconditional prenatal income supplement, smoking cessation wellness programs, parent mentoring programs, and Medicaid expansions.
Training Tool: NYT Video Series on Implicit Bias
The New York Times has a series of short videos on implicit bias (or unconscious bias). A great training tool, the videos purposefully dismantle the "Not me!" reaction so many people have to the concept of bias. They also provide exercises to identify and overcome bias and avoid miscommunication.