RACIST MEDICINE U$A
Black cancer patients 71% more likely to experience heart damage following chemotherapy treatment
Review examines racial disparities in cardiovascular adverse effects from chemotherapy
Reports and ProceedingsChemotherapy is associated with an increased risk of treatment-related heart damage, including heart failure and cerebrovascular disease, for many patients. But a new meta-analysis, presented at the American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient 2023 conference, finds that Black patients or patients of African ancestry have 71% higher odds of cardiotoxicity following cancer treatment compared to White patients.
Cardiotoxicity is any heart damage stemming from cancer treatment or drugs, including chemotherapy agents and radiation. It can lead to several heart problems, including heart failure, cardiomyopathy and irregular heart rhythms. Certain cancer treatments have a higher risk of causing cardiotoxicity, including anthracyclines, which are used to treat leukemias, lymphomas, and cancers of the breast, stomach, uterus, ovary and lung.
“Unfortunately, we were not surprised [by the findings]. Research shows that Black patients have poorer outcomes for almost every disease,” said Wondewossen Gebeyehu, BSc, a medical student at the University of Toronto and lead author of the study. “In this case, one could have expected that the differences would be minimal since it is the chemotherapy that is injuring the heart, and we would expect the same chemotherapy to be given to Black and non-Black patients with a given cancer. However, this systematic review indicates that the inequities in health outcomes extends to the odds of cardiotoxicity after cancer treatment.”
Researchers performed a systematic search of several databases—including Medline, Embase, Pubmed and others—of all studies reporting on cardiovascular toxicity in cancer patients of different racial/ethnic background receiving chemotherapy. After screening 7,057 studies, 24 studies representing 683,749 participants were included in the final review. Black race or African ancestry was associated with 71% increased odds of chemotherapy-associated cardiotoxicity; it was also associated with increased odds of a congestive heart failure diagnosis.
“These results may reflect the direct effects of racism, particularly structural racism, which leads to worse determinants of health for Black patients. It is well-documented that most health care settings are not perceived as safe by Black patients, which may increase their vulnerability to disease and decrease opportunities for preventative care,” Gebeyehu said. “Furthermore, decreased representation of Black patients in clinical trials may lead to treatments being developed that are not as effective or which may be riskier for Black patients. Importantly, these results should prompt further inquiry into the many possible contributors to disparities observed in Black patients.”
According to the researchers, the study quantifies the increased odds of chemotherapy-associated cardiotoxicity for Black cancer patients. The study also highlights the need for further study to determine underlying factors contributing to these disparities so they can be reduced.
“The most important message for patients is that they should not avoid chemotherapy, as the most important thing is making sure they get the best cancer treatment possible, and studies already show Black patients may get less optimal cancer treatments,” Gebeyehu said. “For clinicians, it is important to be aware of these higher odds of cardiotoxicity faced by Black patients. Understanding these disparities will hopefully lead to clinicians having more conversations around reducing cardiovascular risk associated with chemotherapy and targeted efforts to cater to groups at higher risk.”
The American College of Cardiology (ACC) is the global leader in transforming cardiovascular care and improving heart health for all. As the preeminent source of professional medical education for the entire cardiovascular care team since 1949, ACC credentials cardiovascular professionals in over 140 countries who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. Through its world-renowned family of JACC Journals, NCDR registries, ACC Accreditation Services, global network of Member Sections, CardioSmart patient resources and more, the College is committed to ensuring a world where science, knowledge and innovation optimize patient care and outcomes. Learn more at www.ACC.org or follow @ACCinTouch.
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Racial, ethnic differences in barriers faced by medical college admission test examinees
JAMA Health Forum
Peer-Reviewed PublicationAbout The Study: In this study of 81,755 Medical College Admission Test examinees, American Indian or Alaska Native, Black, and Hispanic students reported lower parental educational levels, greater educational and financial barriers, and greater discouragement from pre-health advisers than white students. These barriers may deter groups underrepresented in medicine from applying to and matriculating at medical school.
Authors: Jessica Faiz, M.D., M.S.H.P.M., of the Veterans Affairs Greater Los Angeles Healthcare System and UCLA in Los Angeles, is the corresponding author.
To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/
(doi:10.1001/jamahealthforum.2023.0498)
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Black representation in the primary care physician workforce and its association with population life expectancy
About The Study: The findings of this study of survival outcomes for 1,618 U.S. counties suggest that greater representation of Black primary care physicians (PCPs) in the PCP workforce is associated with improved survival-related outcomes for Black individuals, although there was a dearth of U.S. counties with at least one Black PCP during each study time point. Investments to build a more representative PCP workforce nationally may be important for improving population health.
Authors: John E. Snyder, M.D., M.S., M.P.H., and Rachel D. Upton, Ph.D., of the U.S. Department of Health and Human Services in Rockville, Maryland, are the corresponding authors.
(doi:10.1001/jamanetworkopen.2023.6687)
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About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
The ACMG publishes statement on clinical, technical and environmental biases influencing equitable access to clinical genetics/genomics testing
The American College of Medical Genetics and Genomics (ACMG) has just published: “Clinical, technical, and environmental biases influencing equitable access to clinical genetics/genomics testing: A points to consider statement of the ACMG.”
Peer-Reviewed PublicationWith the goal of fostering awareness and identifying strategies to reduce bias within the medical genetics field and to improve health equity, members of the ACMG’s Social, Ethical and Legal Issues (SELI) and Diversity, Equity and Inclusion (DEI) Committees collaborated to address factors in which bias can occur in clinical genetic testing in a just-published statement, “Clinical, technical, and environmental biases influencing equitable access to clinical genetics/genomics testing: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG)”.
This is the first joint statement of the ACMG’s SELI and DEI Committees. Co-lead author and workgroup co-chair Dena R. Matalon, MD, FACMG, said, “By teaming up with our ACMG DEI colleagues, we were able to address more topics thoughtfully than if we pursued this complex issue in each committee alone. Our goal in working together was to raise awareness about how bias affects all of us, ways in which it does that we may not have realized, how bias affects underrepresented minorities, and what we can do to begin to mitigate it. We ultimately want to provide more equitable clinical genetic care for all, and hope this document helps us take a step in that direction.”
“I am proud of the collaborative efforts of these two ACMG committees in developing this paper in that it reflects an honest and timely response to a set of issues of great importance to society, to the American healthcare enterprise and to members of the clinical team delivering genetic and genomic care to the patients and communities we serve,” said ACMG Interim CEO Robert G. Best, PhD, MS, FACMG. “This paper is a response to the growing recognition that disparities in medicine are common and that they propagate along the lines of race, geography and socioeconomics. The authors of this Points to Consider document articulate an interplay between nested systems within health care related to biases within environmental, clinical and technical domains and have begun to delineate the need for action that takes stock of the complex systems in which patient care plays out. ACMG is committed to learning, understanding and taking responsibility for the part that our discipline has played in sustaining a system that accepts inequity as being somehow beyond the level of our agency to meaningfully address, and this paper represents an early step along a better path.”
As genetic testing becomes more accessible within the US and the world, multiple inherent scientific and clinical biases must be overcome to achieve health equity for individuals for which care is provided, including those belonging to historically marginalized populations. The ACMG SELI and DEI workgroup members reviewed and categorized bias into three main areas: environmental, clinical and technical.
Environmental bias factors in which individuals may face discrimination include employment, medical insurance, housing, and interactions with colleagues, peers and medical institutions. Clinical factors that have contributed to inequities in genetic testing interpretation can encompass limited clinician diversity of representation, access to genetic services, education of both healthcare professionals and patients, and complexities associated with unknown family history and/or genetic ancestry. For example, with few genetics professionals being bilingual, non-English speaking patients are at a disadvantage in receiving culturally appropriate care. Thus, diversifying the genetics workforce must continue to be a high priority.
Lastly, difficulties have arisen in variant interpretation for historically marginalized populations undergoing clinical genetic testing, as most individuals that take part in genomic research studies have been of European descent. Multiple examples are provided in the new ACMG statement regarding these “technical” biases, and the statement highlights the need for an ongoing effort to recruit individuals from ancestral and biogeographically diverse populations to improve database genomic representation.
This document illustrates a framework that supports a positive and constructive dialogue among all stakeholders and lawmakers to continually address biases and keep advancing genetic testing in the clinic. The goal is to recognize and reduce bias, ensuring equitable care and avoiding unfair discrimination for all.
Cinthya J. Zepeda Mendoza, PhD, FACMG, co-lead author and workgroup co-chair, said, “Since its inception almost three years ago, the ACMG’s Diversity, Equity, and Inclusion Committee has been working hard to prioritize DEI principles within the College and the medical genetics specialties. This document is the culmination of a rewarding collaboration with our ACMG SELI colleagues, in which we addressed biases in clinical testing and their significant impact on individuals and communities, particularly those from underrepresented and marginalized backgrounds. Our goal with this publication is to disrupt our bias and to remain accountable in ensuring that individuals from all backgrounds receive the best possible care.”
About the American College of Medical Genetics and Genomics
Founded in 1991, the American College of Medical Genetics and Genomics (ACMG) is a prominent authority in the field of medical genetics and genomics and the only nationally recognized medical professional organization solely dedicated to improving health through the practice of medical genetics and genomics. The only medical specialty society in the US that represents the full spectrum of medical genetics disciplines in a single organization, the ACMG provides education, resources and a voice for more than 2,600 clinical and laboratory geneticists, genetic counselors and other healthcare professionals. ACMG’s mission is to improve health through the clinical and laboratory practice of medical genetics as well as through advocacy, education and clinical research, and to guide the safe and effective integration of genetics and genomics into all of medicine and healthcare, resulting in improved personal and public health. Genetics in Medicine and the new Genetics in Medicine Open, a gold open access journal, are the official ACMG journals. ACMG’s website, www.acmg.net, offers resources including policy statements, practice guidelines, and educational programs. The ACMG Foundation for Genetic and Genomic Medicine works to advance ACMG educational and public health programs through charitable gifts from corporations, foundations and individuals.
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JOURNAL
Genetics in Medicine
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Clinical, technical, and environmental biases influencing equitable access to clinical genetics/genomics testing: A points to consider statement of the ACMG
ARTICLE PUBLICATION DATE
14-Apr-2023
