By Mary Jackson Scroggins and Gwen Darien

The Influence of Doctor Bias

Conscious or unconscious, does it affect cancer treatment for racial and ethnic minorities?

By Mary Jackson Scroggins and Gwen Darien

For more than a decade, patient advocates and researchers have been focusing attention and research on cancer health disparities, including the delivery of substandard cancer therapies to vulnerable patient populations. Yet these concerted efforts have not resulted in a lessening of the unequal burden of cancer.

Juxtaposed with continuing improvements in cancer treatment and survival in the United States, cancer disparities are particularly discouraging—and telling. In fact, recent decreases in the cancer mortality rate for whites are significantly greater than for racial and ethnic minorities.

Clearly, knowing that these disparities exist and funding research aimed at addressing them have not resulted in widespread change. This is a national disgrace—no matter how we frame the discussion.
“The [Institute of Medicine] study committee was struck by the consistency of research findings: even among the better-controlled studies, the vast majority indicated that minorities are less likely than whites to receive needed services, including clinically necessary procedures.”

 —From a brief on the Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Many factors—including socioeconomics, race and ethnicity, gender, education, geography and ZIP code—place people at a disadvantage when it comes to cancer, and specifically when it comes to receiving standard cancer therapy or participating in clinical trials.

The results of a recent study, reported Feb. 15, 2008, in the journal Cancer, highlight the problem of inequality in cancer treatment. The study, by Yale associate professor of medicine Cary P. Gross and his colleagues, was designed to determine whether racial disparities in cancer treatment had decreased since the early 1990s, when such disparities were first documented. The study results were disheartening: Black patients were “significantly less likely” than white patients to receive therapy for lung cancer, breast cancer, colon cancer and prostate cancer during the study period of 1992 to 2002, the researchers wrote. “Efforts in the last decade to mitigate cancer therapy disparities appear to have been unsuccessful.”

Importantly, there is one influence on these disparities that we often avoid discussing: some doctors’ or researchers’ bias and other conscious and unconscious treatment decisions. In a 2003 article in Cancer Epidemiology, Biomarkers & Prevention, surgeon Harold P. Freeman of the Ralph Lauren Center for Cancer Care and Prevention in New York City asked: “What assumptions do doctors make when they see people who are different from themselves?” Evidence suggests “that race does play a role in the provision of medical care,” he wrote. “I believe the common thread in these findings is a subtle form of racial bias on the part of medical care providers. The level and extent of this problem are unknown, but it is real and potentially harmful, although predominantly unintentional.”

With regard to cancer health disparities in general, speculation and science are tightly interlaced. But in our discussion here, no distractions of biology and genetics exist: We are talking about people making decisions that result in unequal, often substandard treatment for select patients.