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Perceived bias tied to lower cancer screening rates

NEW YORK (Reuters Health) - Minority men and women who believe their health providers are biased against them are less likely to be screened for breast and colon cancers, a new study suggests.

In a survey of more than 11,000 minority adults, researchers at Stanford University found that women who perceived discrimination from their health provider were one third less likely to have been screened for colorectal cancer as women who reported no such discrimination.

When it came to breast cancer screening, these women were only about half as likely to have had a mammogram.

The study also found that among men who had a regular source of healthcare, those who perceived discrimination were 70 percent less likely to have been screened for colorectal cancer.

The results are published in the journal Cancer Epidemiology, Biomarkers and Prevention.

It’s not clear exactly what doctors and other health providers are doing to make some minority patients feel discriminated against, according to the researchers.

“Respondents answered yes or no to ‘was there ever a time that you would have gotten better medical care if you had belonged to a different ethnic group?’” lead researcher Dr. LaVera M. Crawley explained in a statement from the American Association for Cancer Research. “However, we were not able to ask why they felt discriminated against.”

Whether perceived discrimination is real or not, conscious or unintentional, it could have significant effects on patients, according to Crawley, an assistant professor at the Stanford’s Center for Biomedical Ethics in Palo Alto, California.

“The longer someone delays (cancer) screening the worse the outcome,” she said. “Perception of discrimination may be driving the differences we see in outcomes among minorities.”

The findings are based on a survey of 11,245 black, Hispanic, Asian and Native American adults between the ages of 40 and 75. Roughly 9 percent of women said they had perceived some form of healthcare discrimination in the past 5 years, as did 6 percent of men.

“We have yet to achieve bias-free health care,” Crawley said. “This has serious public health implications as we know that higher levels of screening lead to lower levels of mortality.”

“Clinicians need to be aware that they may be sending signals, even unintentionally, that lead minorities to believe they are being discriminated against,” she added.

Delayed cancer screening can carry heavy consequences, Crawley noted.

When colon and breast cancers are caught early, the 5-year survival rates are about 90 percent; when the diseases are detected in late stages, however, those figures drop to 23 percent for breast cancer and just 10 percent for colon cancer.

SOURCE: Cancer Epidemiology, Biomarkers and Prevention, August 2008.

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