Race Matters
Perceived discrimination reduces cancer screening
While it has long been known that
cancer screening behavior differs
among racial and ethnic groups,
the causes of this discrepancy
have remained unclear. Now, new
research is offering some insight:
a report published in the august
2008 Cancer Epidemiology,
Biomarkers & Prevention suggests
that minority women who believe
their medical caregivers discriminate
against them are substantially less
likely to be screened for breast
cancer and colorectal cancer.
laVera M. Crawley, a biomedical
ethicist at Stanford university
in Stanford, Calif., and her
colleagues crunched numbers
from telephone surveys of more
than 11,000 Californians, including
african-americans, Native
americans, asians and latinos.
“Women who had perceived
medical discrimination within
the past five years were two-thirds as likely to be screened for
colorectal cancer and more than
half as likely to have received
a mammogram compared with
women who did not perceive
medical discrimination,” the
researchers report. among men,
perceived medical discrimination
was not associated with decreased
screening rates—except,
surprisingly, for those men who
had a consistent source of
medical care.
While the study specifically
addressed perception of
Patients who feel discriminated against by health care professionals are less
likely to adhere to cancer screening guidelines.
CR | Page No. 10 | Winter 2009
discrimination, barbara a. brenner, screen women at average risk for
the executive director of the breast cancer, the aCS and uSPSTF
advocacy group breast Cancer recommend mammography
action, argues that the distinction starting at 40. In future studies,
between perceived and actual Crawley hopes to home in on the
discrimination is irrelevant. precise cues that make a patient
“If what you’re looking at is feel unfairly treated so that
outcomes,” says brenner, “then clinicians can strive to eliminate
it doesn’t matter whether it’s those triggers. “We really need to
real or perceived. It’s real to characterize what exactly people
the person whose behavior was are perceiving,” she says.
affected.” While the effect of perceived
Crawley agrees. What matters, discrimination was pronounced,
she says, is that women who it was limited to a relatively
feel discriminated against seem small group of patients. Only 9
less likely to adhere to screening percent of the surveyed women
guidelines—even if their health reported that they felt medically
care providers mean no harm. For discriminated against during
people at average risk of colorectal the previous five years. Crawley,
cancer, the american Cancer who notes that discrimination is
Society (aCS) and u.S. Preventive usually underreported, suspects
Services Task Force (uSPSTF) the real proportion may be larger.
recommend colorectal cancer “The problem is bigger than the
screening starting at age 50. To numbers,” she says.
