This large study found that African American and other minority women and men who believe they've experienced some form of discrimination in medical care are less likely to get breast and colon cancer screening than people who don't believe they've experienced discrimination in medical care.
The people in this study were African Americans, American Indian/Alaskan Natives, Asians, and Latinos living in California. More than 8,000 women, age 40 to 75, and more than 3,100 men, age 50 to 75, participated.
Women who have an average risk of breast cancer should have a screening mammogram every year, starting at age 40. All of the women in this study were 40 or older, so all of them should have had a mammogram within a year of enrolling in the study. But only 60% of the women in the study had a mammogram within one year. Only 42% of the women were screened for colon cancer screening as recommended.
Almost 9% of women in the study reported experiencing discrimination in medical care in the 5 years before joining the study. The women who reported medical care discrimination were 48% less likely to have a mammogram within a year compared to women who didn't report medical discrimination. The women who reported medical discrimination were also 34% less likely to have recommended colon cancer screening compared to women who didn't report medical discrimination.
About 6% of the men in the study reported experiencing medical care discrimination. Overall, men who reported discrimination were just as likely as men who didn't report discrimination to get recommended colon cancer screenings. But men who reported discrimination AND had one main place where they went for health care were 70% less likely to get recommended colon cancer screenings than men who didn't report discrimination.
Breast cancer in African American women is genetically different than breast cancer in white women. Breast cancers diagnosed in African American women are usually:
Other research has shown that that African American and other non-white women are less likely than white women to be screened for breast cancer and get the most aggressive treatment. The reasons for these differences aren't very clear. Less access to regular healthcare, as well as social and financial issues (a lack of insurance), are probably big reasons for some minority women. More than half of the people in the study reviewed here had at least some college education, about 85% had health insurance, and more than 90% reported a usual source of care. This suggests that other factors, such as perceiving discrimination in medical care, were responsible for the results.
Regular screening is the best way to find any cancer early, when it's most treatable. Don't let anything get in the way -- including medical discrimination -- of doing what's best for YOU.
PALO ALTO, Calif., Aug. 6 (MedPage Today) -- Perceived discrimination in medical care translated into lower rates of screening for breast and colorectal cancer in minority patients, investigators here found.
Patients who perceived discrimination in the healthcare setting were up to 70% less likely to be screened, LaVera M. Crawley, M.D., of Stanford, and colleagues, reported in the August issue of Cancer Epidemiology Biomarkers and Prevention.
Overall, women were influenced more than men by the perception of discrimination.
However, the lowest screening rates were among men who had a usual source of care and sensed discrimination.
"These findings of a significant association between perceived racial or ethnic-based medical discrimination and cancer screening behaviors have serious implications for cancer health disparities," the authors concluded.
However, they cautioned that "we cannot know whether the reported events represented actual discriminatory acts or if perception of discrimination was accurate. Clearly, more research is needed to confirm these initial findings and to explain the gender differences as well as to explore important subgroup differences."
In a 2002 report on unequal treatment in American health care, the Institute of Medicine expressed concern that racial and ethnic discrimination may play a major role in health-care disparities.
Although difficult to measure directly, discrimination, either real or perceived, has been shown to affect health-seeking behaviors, such as preventive services, the authors said.
Most studies that have examined perceived discrimination and health outcomes have focused on generalized discrimination, rather than medical discrimination (related to the care received), they continued.
To examine the impact of perceived medical discrimination on cancer screening, the investigators reviewed data from the 2003 and 2005 California Health Interview Survey. Both surveys elicited information about minority respondents' perception of discrimination in the healthcare setting.
The study involved a total of 11,245 African-American, American Indian/Alaskan Native, Asian, and Latino adults, comprising 8,051 women ages 40 to 75 and 3,194 men ages 50 to 75.
More than half had at least some college education, about 85% had health insurance, and more than 90% reported a usual source of care.
The primary outcome measures were rates of screening for colorectal cancer in men and women ages 50 to 75 and rates of breast cancer screening in women ages 40 to 75.
The overall screening rate for colorectal cancer (endoscopy within the past five years and/or fecal occult blood testing within the past year) was 41.8% among women and 43.4% among men.
About 60% of the women reported having a mammogram within the past year.
The responses showed that 8.9% of women and 6.2% of men had perceived medical discrimination within the past five years.
As compared with respondents who reported no discrimination, women who perceived medical discrimination were 34% less likely to be screened for colorectal cancer (OR 0.66, 95% CI 0.64 to 0.69) and 48% less likely to be screened for breast cancer (OR 0.52, 95% CI 0.51 to 0.54).
Men who perceived discrimination were just as likely to be screened for colorectal cancer as those who reported no discrimination (OR 1.02, 95% CI 0.97 to 1.07).
However, men who perceived discrimination and reported having a usual source of care were 70% less likely to be screened (OR 0.30, 95% CI 0.28 to 0.32).
The findings suggest that "some persons may delay or avoid getting screened for cancers and that this delay may be associated with racial or ethnic-based experiences they encounter within the medical setting," the authors said.
The authors acknowledged that a cross-sectional survey precludes an examination of causality.
They also noted a potential for sample bias because of low response rates to the surveys (33.5% in 2003 and 26.9% in 2005).
The authors reported no disclosures.
Primary source: Cancer Epidemiology, Biomarkers & Prevention Source reference: Crawley LM et al. "Perceived medical discrimination and cancer screening behaviors of racial and ethnic minority adults." Cancer Epidemiol Biomarkers Prev. 2008; 17: OF1-8.
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