The New York Times takes note of a recent journal article about the incidence of cervical cancer:
The death rate from cervical cancer in the United States is considerably higher than previously estimated and the disparity in death rates between black women and white women is significantly wider, according to a study published Monday in the journal Cancer.
The rate at which black American women are dying from the disease is comparable to that of women in many poor developing nations, researchers reported. What makes the findings especially disturbing, said experts not involved in the research, is that when screening guidelines and follow-up monitoring are pursued, cervical cancer is largely preventable.
I wonder if they controlled for income in the study?
The questions that arise from those findings are many. Do poor people receive healthcare that doesn’t conform to the standard of care? Or is it just black women? Do black women seek care less frequently or under different circumstances than white women do? When controlled for income, education, and area of the country are the results the same?
Are their doctors unaware of the standard of care? Are they less ethical? Are they just too busy? Does it make a difference whether their physicians are trained here or IMGs?
The article, and presumably the study it was based on, raises a lot of questions. I’m wary of jumping straight to unequal access to care, without strong controls.
Are there genetic differences that make black women more susceptible to cervical cancer? Sickle cell disease discriminates based on race, cervical cancer may as well.
(I mean, if I had to guess, I would assume it was poverty and lack of health care, but it’s foolish to assume that this is the only cause)
There are any number of possibilities. I’d like to know more before I got behind any policy recommendations. My gut level reaction is that although race plays a role the greater factors are poverty and delivery.
Here is a suggestion, and I think all right thinking progressives will get behind. We need single payer, and with the government paying, we need to level the playing field. There should be no more segregation (“white privilege” for the squeamish), and like with schooling, there should be busing to enforce integration, racially and economically.
Rich white women can visit the GYN at the clinic in the inner city, and the poor women can visit the GYN at the up-to-date medical center in the well to do areas. If distance is a problem, housing will be a provided.
It’s a topic that’s hotly debated but outcomes appear to be affected by Medicaid status.
It doesn’t look like the study controlled for income. They evaluated: age, state, year, and race. Abstract:
http://onlinelibrary.wiley.com/doi/10.1002/cncr.30507/full
I’m trying to get my head around this: (1) Black women are more likely to receive hysterectomies; (2) a hysterectomy may be for reasons that have to do with cancer or not; and (3) a hysterectomy “almost always” removes the cervix, thus “almost always” precludes cervical cancer.
I can see why you would adjust for hysterectomies given (3), particularly if you were an insurance company creating acturarial tables. But (1) and (2) point to a lot of issues concerning why black women are more likely to have a hysterectomy and particularly what reason. They are somewhat saying that black women are more likely to have been “cured” of the risk of cervical cancer with a hysterectomy, though that was not the purpose. For public health policy it seems like we need more information about (1) and (2), rather than about cervical cancer.
Here I have had a view of this type of thing for 40 years. I am a devil White but my wife is Native American and has received attention from Indian Health Services, under the B.I.A, under the Dept. of the Interior.
Also I’ve experienced the health care of dozens of her relatives who live on reservation, which we do not.
My experience is this, Health care is very good for those with some education who are proactive about their health. But many simply do not believe the doctors, do not understand, or simply don’t comply with medical regimens. Many simply die at home out of fear of going to the clinic and having their fears confirmed. And then there are those who prefer traditional holy men and sweat lodge ceremonies. (They just don’t believe the doctors).
And people ask, how do you solve this? I say, is it a problem to be solved? No one lives forever, not even Dick Cheney, who has extended his life with a heart transplant.
Can probably find the study if I search, but the GYN folks tell me that black women have more trouble clearing HPV. In the study they cite, the incidence of HPV was about the same for white and black women and both groups reported the same number of sex partners. (This is from memory so could have some of this wrong.) Anyway, when they followed infected white and black women, the black women stayed infected longer.
That said, most people think access to screening and then poor follow up are factors. From the NCI
https://www.cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet#q7
PD- Guess we aren’t supposed to talk about unethical practices in medicine, but high rates of hysterectomies for poor people is not surprising. In Florida, harvesting uteri was a big money maker and the minority patients were easier to talk into the procedure.
Steve