The designation of race as a risk factor for disease is ubiquitous in the medical literature, including journals devoted to the specialty of oncology. The last of seven questions posed by the National Cancer Institute’s Breast Cancer Risk Assessment tool for healthcare professionals is "What is the woman’s race/ethnicity?" In addition, the American Cancer Society tells us "breast cancer is more common in African-American women" under 45 years of age, and that "African-American women are more likely to die of this cancer" than women of other races.
The use of race and ethnicity in calculating risk for diseases such as breast cancer has drawn sharp criticism from many quarters for some years. "It is completely unjustified scientifically to talk about genetic differences between US racial populations," says Judy Kaplan, MS, a freelance public health and medical editor, who has published on topic. "Studies that purport to show differences by race in cancer characteristics are actually reporting baseline differences between the study groups. If you start out with black women who are sicker because they are diagnosed later and compare them to white women who (on average) are less sick and diagnosed sooner, then -- no surprise -- the black women have more serious cancers."
A study conducted by the California Breast Cancer Research Program and reported a decade ago bolsters her argument. Researchers sought to determine whether the relationship between socioeconomic factors and stage at diagnosis for breast cancer varies among racial/ethnic groups and the degree to which the relationship depends on how stage at diagnosis is measured. The researchers evaluated the importance of considering race for monitoring breast cancer incidence rates. They concluded that risk factors significantly related to socioeconomic factors "may act as a surrogate" for race/ethnicity in such analyses.
Debby A. Phillips, ARNP, CS, PhD, and Denise J. Drevdahl, RN, PhD, wrote in a 2003 article published in Advances in Nursing Science:
Persistent attention to particular racial and ethnic groups as suffering a disproportionate share of certain illnesses or diseases (a common strategy in health disparity research) reinforces the belief that interventions around disease prevention and health promotion are the primary solution to these problems. This position ignores other larger socioenvironmental issues such as poverty, unemployment, and inadequate education… This perspective is so entrenched that whole industries have sprung up around racial and ethnic differences, including health conferences, national initiatives, and centers on health disparities in vulnerable population…
The reality that contemporary language conflates race and ethnicity with vulnerable populations can be understood as a historical and politically correct shift from the dominant culture language of years ago when race and ethnicity were more explicitly conflated with non-white and inferior. Language change notwithstanding, discriminatory practices continue to produce adverse health outcomes, much of which are unresearched and undocumented.
Kaplan says that a population rate should not be confused with individual risk. "An African-American oncology nurse does not have the same risk for disease as an unemployed African-American woman with a starchy, fatty diet who lives in a dangerous, stressful environment next to a toxic dump."
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