Prejuicios de los proveedores médicos y las examinaciones y tratamientos de cáncer de colon
For nearly eight months, Jenna Scott had an ideal pregnancy. Then she began experiencing bleeding, dizziness and abdominal pain.
Scott, 29, was afraid something was wrong with her baby, but her OB-GYN told her everything was fine after a checkup. It was possible her baby was sitting on her organs or maybe she was experiencing pregnancy-induced hemorrhoids, which is common. The abdominal problems were explained as typical pregnancy aches and pains.
Having never been pregnant before, Scott didn’t know what was normal and what wasn’t. But even after the birth of her son, Cameron, the rectal bleeding continued and Scott was exhausted. She was told that intense fatigue is normal for a new mother and that it was possible she still had hemorrhoids.
When nothing changed a year after giving birth, Scott realized she needed to see a primary care physician. There, she was referred to a GI specialist who asked her to undergo a colonoscopy to rule out more significant problems. Instead, the test confirmed something no one expected: At 31, Scott had colorectal cancer. She later learned it was stage 4.
Read: My doctor ignored my colon cancer warning signs because he thought they were normal pregnancy symptoms >>
Scott knows that because of his young age, healthy lifestyle, and lack of family history of colon cancer, medical providers were less likely to offer screenings, even if rectal bleeding and abdominal pain were Typical symptoms of colon cancer. He’s not entirely sure if racial bias played a role, but she was a black woman with a team of white doctors. Scott said the medical providers at her OB-GYN clinic were very apologetic when they were told of her diagnosis.
The black characters are less likely to be referred for colon cancer screening by their doctors and to be examinedwhich raises questions about whether medical provider biases are contributing factors to the worse outcomes for many people of color. Native Americans and Alaskans have the highest rates of colorectal cancer, followed by black men and women. Black patients have the highest rates of colorectal cancer, followed by black men and women. Mortality rates of major companies of that disorder.
Dr. Renee Williams, MHPEa gastroenterologist at NYU Langone Health, has studied the possible reasons why black patients are less likely to be referred for colon cancer screeningto cancer-related services and surgical services. She said there could be bias if a medical provider thinks a patient doesn’t want screening or can’t afford it, especially if they don’t have health insurance, but she sees social determinants of health and other external factors playing larger roles in screening disparities.
Screenings are extremely important because polyps can be removed before they turn into cancer and Survival rates are high if colorectal cancer is treated early. Routine screening has led to a decline in the mortality rate from colon cancer for several decades.
“There are definitely provider biases, and they exist for all physicians regardless of their background, but I think it’s more than that,” Williams said. “Often, providers just don’t have a lot of time available. If you have 20 minutes to have a consultation with their patients and they have diabetes, high blood pressure or heart conditions, they’re going to spend a lot of time dealing with that. Talking about routine screenings might become less important.”
Food swamps, food deserts and lack of access
The obesity It is a risk factor for colorectal cancer and a study of more than 3,000 communities found that people living in a food desert, where there is little or no access to affordable nutritious or fresh food, or in a food swamp, an area with a high rate of convenience stores and fast food restaurants compared to supermarkets, have a Increased risk of cancer related to obesityAreas with food deserts or food swamps also have higher rates of poverty, more people with obesity, and a higher percentage of non-Hispanic black residents.
Residents in these areas may also be less likely to have regular jobs and may have lower levels of education and health knowledge, making it difficult for them to advocate for their own rights regarding cancer-related screening and treatment with medical providers.
The removal of racial and ethnic data from the clinical algorithms and medical technology that contributed to health disparities has ameliorated racial bias in some areas. But some researchers have questioned whether that could also lead to worse colorectal cancer outcomes for black patients in the future because there might not be red flags for screening recommendations.
Read: Racial bias in medical technology can lead to health inequalities >>
Williams mentioned two significant initiatives that have proven effective in reducing racial disparities in colon cancer screening and mortality rates. In 2002, the state of Delaware implemented a state-level program which included coverage of screening and treatment, which helped a percentage of black people receive colorectal cancer diagnoses, thereby eliminating racial differences in mortality rates. Citywide Colorectal Cancer Control Coalition [Coalición de la ciudad de control de cáncer colorrectal] (C5) Similar increases in screening rates for black patients were also reported in New York City.
Community-based initiatives such as offering information at churches, medical fairs and other trusted locations can also be helpful in increasing screening rates. Some medical networks send text messages to patients when they turn 45 suggesting they get colon cancer screenings with links to scheduling options.
On a personal level, Williams suggests that patients themselves bring up the issue with a medical provider.
“If you’re at average risk and you’re 45, you can start the conversation by saying, ‘I’m interested in getting screened for colon cancer. What are my options? ’” Williams said.
The Scott Trial
In 2021, colon cancer screening guidelines were reduced to age 45 years Because the rise in colon cancer in younger people like Scott is a growing concern.
Scott’s life has been marked by rounds of surgeries, chemotherapy and trips to the emergency room for much of the past seven years. She was often in the hospital alone because her husband had to care for Cameron or because isolation protocols restricted visitors during the Covid pandemic. The cancer spread to Scott’s liver and lungs, and she developed melanoma on her foot, which required surgical removal of part of her heel.
There were some moments of relief; for a year and a half period from 2021 to 2022, Scott was cancer-free and thought his life would return to normal. In December 2022, however, cancer was found in the lymph nodes in his chest and in the area between his lungs. His medical providers told him he must undergo three days straight of chemotherapy with three-week rest periods in between for the rest of his life.
Although Scott said it wouldn’t have occurred to him to ask his providers for a colon cancer screening, he said if he could do things differently, he would have pushed harder for answers. He encourages others to do the same.
“Tell your doctor that you won’t leave until he or she further evaluates your problem because you know your body and you know something is wrong,” Scott said. “And, make sure you have regular consultations with a primary care physician even if you are pregnant. You should do your best to stand up for yourself and always seek a second opinion. I just wish I had known that sooner.”
Resources
Alliance against colorectal cancer [Alianza contra el cáncer colorrectal]
This educational resource was prepared with support from Merck.
