Race, gender and the ways these identities intersect in cancer outcomes


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By Timothy Pawlik, The Ohio State University† Elizabeth Palmer, The Ohio State Universityand Samilia Obeng-gyasi, The Ohio State University

The Research Brief is a brief look at interesting academic work.

the big idea

Belonging to one or more groups with long-term social and economic disadvantages increases the risk of cancer diagnoses and death, according to our review of 28 cancer studies published between 2012 and 2021.

For example, people who were both non-white and LGBTQ got fewer cancer prevention services and had fewer cancer screenings, we found.

We started looking for studies of groups with poor cancer outcomes. We then narrowed our focus to cancer studies that specified the race, sexual orientation, gender identity, socioeconomic status, disability status, or rural residence of study participants. We found only 28 who provided such information. We categorized those studies by the aspect of cancer care that they covered. For example, some studies have focused on cancer screening and prevention, while others have focused on treatment.

Most studies focused on what people did to prevent or control cancer. Examples include getting mammograms or a vaccine against the human papilloma virus. And we found some studies that dealt with specific types of cancer, such as cervical cancer or breast cancer.

We found that sexual orientation and race influenced women’s choice to be screened for cancer or receive preventive treatments. Non-white women of low socioeconomic status also had lower cancer survival rates. We saw that these patients experienced a fear of discrimination, a general unease among caregivers and a greater distrust of the health care system.

Why it matters

Despite advances in detection and treatment, cancer remains the second leading cause of death in the United States. And in communities with long-term social and economic disadvantages, the risk of cancer diagnoses and death is higher than in the general population.

For example, black women are more likely than white women to die from breast cancer. New prostate cancer diagnoses are more common in rural Appalachia, compared to urban areas in the same region. And bisexual women are 70% more likely to be diagnosed with cancer, compared to heterosexual women.

Cancer care research tends to ignore the multiple identities of individual patients. But most people have more than one social identity, and those identities are hard to separate. For example, a gay black man is not gay one day and black the next; he’s both, all the time. And he has different experiences of discrimination and disadvantage compared to a straight black man.

Intersectionality describes the recognition and consideration of a person’s multiple, intersecting social identities. Taking these multiple identities into account could help improve cancer prevention and survival in those who belong to one or more historically disadvantaged groups.

What is not yet known

We did not look at lifestyle behaviors, such as smoking, that could increase the risk of developing cancer and contribute to poorer cancer treatment outcomes. However, cancer differences based on lifestyle behaviors are well documented and it would be valuable to look at how complex identities and lifestyle influence those outcomes.

As researchers, we wanted to focus on identifying studies in the literature that focused on the interconnected, multiple ways patients identify themselves and how this relates to their health care. Unfortunately, only a small amount of data was available and our current report suffered from these limitations.

What’s next

Our paper describes ways in which scientists can take into account the multiple identities of patients when conducting cancer research. This model contains recommendations for designing studies, conducting the research itself and documenting the findings. Considering more complex patient identities could make future studies more consistent and understandable. It will help fill some of the major gaps we see in the way researchers study cancer.The conversation

Timothy Pawlik, professor of surgery, The Ohio State University† Elizabeth Palmer, research scientist, The Ohio State Universityand Samilia Obeng-Gyasi, assistant professor of surgical oncology, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.