By Steve Blanchard - February 02, 2022
Yvette Gray knew she needed to schedule a mammogram when she discovered a suspicious lump in her breast during a self-exam. The assistant federal defender sought the care of specialists near her home in Fort Myers but soon discovered she had an additional battle to face alongside her cancer: racial bias.
Gray, 56, who is Black, said she has run into bias before in health care but was still disappointed when communication surrounding her breast diagnosis was sporadic and incomplete. She said when she interacted with her local doctors, she felt more like a statistic than a patient.
“I wasn’t pleased after that initial meeting,” Gray said. “The doctor never looked me in the eyes, didn’t explain much to me and I felt rushed. We all know there are stereotypes and implicit bias, but it’s especially prevalent in health care.”
Unfortunately, Gray’s experience isn’t unique. According to Dr. Kimberley Lee, a medical oncologist in Moffitt Cancer Center’s Department of Breast Oncology, there are large differences in the way in which Black women receive treatment for breast cancer compared to their white counterparts. In fact, the disparities are so great that more Black women are likely to die of breast cancer, specifically HER2 negative breast cancer, even though it is more treatable.
Lee wants to understand why.
“My current work is to understand what is happening with the treatment,” Lee said. “Are Black women getting appropriate treatment for this cancer? Are they responding the same way?”
"My current work is to understand what is happening with the treatment."- Dr. Kimberley Lee, medical oncologist
Focused on Care Delivery
Lee is focused on understanding racial disparities in survival for women with hormone receptor negative breast cancer.
Endocrine therapy or hormone-blocking medications are used to treat breast cancers that express hormone receptors such as estrogen and progesterone. These types of cancer feed off hormones in the body, so endocrine therapy decreases the levels of these hormones, essentially starving the cancer of the food it needs.
“My work is focused on care delivery,” Lee said. “My work focuses on the science of how we get appropriate care to all people. We know that Black women are more likely to be undertreated or mistreated and less likely to get the drugs or surgery that they need. I am focusing on how we give them the things we know that work and focusing on that care delivery piece.”
Gray is part of that study, and she was more than happy to assist Lee with her research, especially if it will help other Black women, and patients in general, receive the information and treatment they deserve.
Sometimes the answer is as simple as communicating clearly and asking the patient the right questions, Gray said.
“She asked me questions about being a Black woman and having this happen and the experience I’ve had so far,” Gray said. “Dr. Lee and my surgeon, Dr. (Nazanin) Khakpour, have both called me personally to check in and to update me. This research is so important, not only for patients like me, but for the doctors who are treating us. They need to see and hear and read this research and understand it so they can do better.”
Pills and Their Side Effects
And that, of course, starts in the clinic. According to Lee, the disparities among Black breast cancer patients start in the prescription of pills. After surgery, breast cancer patients are given medication to reduce their risk of recurrence and are prescribed to take it for five to 10 years. However, Black women are less likely to start these life-saving medications, and those who do are less likely to take it every day and stay on it for the recommended time. The reason behind this is unclear, Lee said, but it could be linked to the side effects.
The medications cause symptoms similar to menopause, as well as others, and can be distressing if not managed appropriately. Some studies have shown that Black women have worse symptoms from the medications than white women, but Lee says this has not been fully borne out.
“Deciding to quit the medication early could be linked to side effects and coping with those or a lack of communication with the patient’s health care team is contributing to that,” Lee said. “If you can’t get the help you need or you can’t communicate, you might decide to stop taking the treatment.”
Another piece could be that some patients simply don’t understand the importance of taking the medication and may assume that because they are no longer actively being treated for cancer — as in chemotherapy or radiation — any kind of oral treatment just isn’t necessary.
“Some women just may not want to think about breast cancer anymore and say, ‘I’ve been treated, I want to be done,’ ” Lee said. “Pills are a reminder of that experience so that could contribute to them stopping.”
Patients and Providers Shed Light
For her study, Lee is looking at 30 patients and 10 providers. She is having in-depth conversation with each participant and has found that clinicians especially are thankful for the research and are eager to participate.
“The clinicians have all agreed that this work is important,” Lee said. “One factor contributing to disparities in the Black community is distrust in the health care experience. Many think that researchers are experimenting on them and not including them in the conversation. I think this kind of study on this group can help with that sense of here is an institution trying to do something for us.”
While Gray has completed her active treatment and is essentially cancer free, she understands the importance of continuously monitoring her condition and following the directions of her health care specialists. It’s important, she said, that Black women in general also understand this and stresses that treating Black women in a supportive and nonjudgmental environment is the best first step to overcoming disparities in this area.
“We fear that judgment and we fear that our concerns are minimized by doctors at times,” Gray said. “Too often they just overlook treating us as a person and as a woman and discount some of our unique situations as Black women.”
Once health care professionals understand that and listen to individual patients rather than assuming any type of bias, health equity will finally be in sight.
“When your doctor does better, it’s better for the patient,” Gray said.