HEALTH NEWS(1)
Colon Cancer Screening Low Among African Americans
Mon Feb 2, 2004 - From Reuters
Health
By Will Boggs, MD
NEW YORK (Reuters Health) - African Americans on Medicare -- and therefore with apparently equal access to healthcare -- are less likely than Caucasians to undergo colorectal cancer screening, a study shows.
African Americans are diagnosed more frequently with colorectal cancer at later stages than are Caucasians, the authors explain in the medical journal Cancer. However, previous studies have not investigated whether screening and diagnostic procedures differ between the races.
Dr. Gregory S. Cooper and Dr. Siran M. Koroukian from Case Western Reserve University in Cleveland, Ohio, investigated the use of fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, or barium enema exams among approximately 33.8 million Medicare beneficiaries during 1999.
Sigmoidoscopy, colonoscopy, and FOBT were performed significantly more commonly in Caucasians than in African Americans, the authors report, whereas barium enema was performed more commonly in African Americans.
In contrast, studies of the upper gastrointestinal tract were performed more often in African American patients than in Caucasian patients, the investigators write, suggesting "that the observed racial differences with respect to colorectal procedures are not due merely to an inability to access endoscopic or radiologic facilities."
So what might be the reason? "The implication is that for whatever reason, blacks may wait until they're symptomatic to get testing rather than go for routine screening or polyp follow up," Cooper told Reuters Health.
"We know that blacks are more likely to present with advanced stage colon cancer, and this may well be one of the major reasons," he added.
"The next step in addressing racial disparities would be to determine what is driving it," Cooper said. "Is it that blacks are less likely to adhere to physician screening recommendations? Are physicians less likely to recommend certain tests to black patients? These answers can only be obtained from more qualitative studies."
SOURCE: Cancer, January 15, 2004.
Related
Topic
Blacks Still Mistrust
U.S. Medical System - Study Suggests
WASHINGTON (Reuters) - Up
to 80 percent of U.S. blacks and 52 percent of whites believe that they or
"people like them" could be used as guinea pigs for medical research
without their consent, a survey published Monday found.
The survey, published in the Archives of Internal Medicine (news
- web
sites), suggested that most blacks do not trust their doctors, and also
suggested that it will be hard to get African-Americans to take part in medical
trials.
"As a society, we want the very best medical care," Dr. Giselle
Corbie-Smith, an assistant professor of social medicine and internal medicine at
the University of North Carolina, Chapel Hill, who led the study, said in a
statement.
"This care is based on evidence from medical research. Yet it appears
that many of us as individuals distrust the research enterprise and are
unwilling to participate in it. This is a critical disconnect."
Blacks still remember the notorious Tuskegee study in which Alabama blacks
were allowed to go untreated for syphilis between 1932 and 1972 -- even though
doctors knew antibiotics could cure them. The doctors wanted to study the
"natural course" of the disease.
"Since the Tuskegee syphilis study, we've known that large numbers of
African-Americans distrust the research community," Corbie-Smith said.
"Now we know that many whites share that same fear."
She said the fears could hurt efforts to do important medical research.
For the study researchers interviewed 500 blacks and 400 whites across the
country.
They found that 63 percent of the African Americans and 38 percent of whites
surveyed believed doctors often prescribe medication as a way of experimenting
on people without their knowledge.
One-quarter of blacks and 8 percent of whites thought their doctors had given
them treatment at some time as part of an experiment without their permission.
MEDICAL SCHOOL LEADERSHIP URGES RACE-BASED
CONSIDERATION
HEALTH BEHAVIOR NEWS SERVICE
In the face of legal challenges to affirmative action, leaders of the U.S.
medical school establishment are calling for the use of race-conscious decision
making as “the best means available for closing the diversity gap” in medical
school admissions.
Writing in the 2002 September/October edition of Health Affairs, Jordan J.
Cohen, president of the Association of American Medical Colleges, and colleagues
Barbara A. Gabriel and Charles Terrell argue that attaining greater diversity in
the health care workforce will advance cultural
competency among providers, increase access to high-quality health services for
minorities, strengthen the medical research agenda and ensure better management
of the health care system.
“Given the rapidly changing U.S. demography, it is axiomatic that the majority
of future health care professionals will be called upon to care for many
patients with backgrounds far different from their own,” they write.
“To do so effectively, health care providers must have a firm understanding of
how and why different belief systems, cultural biases, ethnic origins, family
structures and a host of other culturally determined factors influence the
manner in which people experience illness, adhere to
medical advice and respond to treatment.”
Citing 1999 statistics, the article says that while African-Americans and
Hispanics each made up about 12 percent of the U.S. population, they made up 2.6
percent and 3.5 percent of the physician workforce, respectively.
The most important solution, the authors say, is to address disparities in
primary, secondary and undergraduate education so that minorities would have
equivalent academic credentials when applying to medical school. “In the interim
… the best means available for closing the diversity
gap is to use affirmative action, race-conscious decision making in higher
education in general and in medical and other health professions schools in
particular.”
The authors argue that such a practice will not result in a lowering of
standards. “Given the numerous academic hurdles that must be cleared in medical
school, in residency training and in acquiring a license, the chances that an
unqualified person will make it into practice are
exceedingly small,” they write.
Terrell is vice president of the AAMC’s Division of Community and Minority
Programs, and Gabriel is senior writer and editor for the AAMC.
# # #
FOR MORE INFORMATION
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Health Affairs: For copies of the article, contact Jon Gardner at (301)
656-7401, ext. 230 or
jgardner@projecthope.org.
