Otis Brawley: Certain Cancer Screening Tests Have Exacerbated Health Disparities

November 2, 2020
Briana Contreras
Briana Contreras

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Peter Wehrwein
Peter Wehrwein

The Johns Hopkins professor and new MHE editorial advisory board member discusses screening among race, how certain screening tests intensify health disparities and how the Trump administration is not correctly applying science within healthcare in this final part of a four-part video series.

Back in late September, Managed Healthcare Executive's Senior Editor Peter Wehrwein and Associate Editor Briana Contreras spoke with Otis Brawley, former chief medical and scientific officer for the American Cancer Society and now a professor of oncology and epidemiology at Johns Hopkins, about cancer screening guidelines that address those of different races and if these screenings have exacerbated the opportunity for health disparities.

First, Brawley, who is a new member of MHE's Editorial Advisory Board, believes certain screenings have exacerbated health disparities.

He gives an example of how the death rate for black and white men and women in colorectal cancer in the 1970s was the same, as well as breast cancer in women during the same period. However, when screening and treatment improvements were developed in the late 70s and early 80s, disparities in death rates for blacks and whites had greatly grown and widened in colorectal and breast cancer by the 90s.

Related: Otis Brawley: It’s Gotten Better but Problems With Cancer Screening Haven’t Gone Away

"Screening and improvements and treatment do cause disparities because there's a group of people who get it and a group of people who don't," he says. "It causes socio-economic disparities as well, you know, we don't have graphs of poor white people versus middle class white people, but if we did, there would be a disparity there too."

Secondly, in terms of racial guidelines for screening, Brawley believes race is a socio-economic categorization of a population that has nothing to do with biology.

"I have a very, very good friend, who's fond of saying, 'To divide the American population in five racial and ethnic categories, is like trying to slice soup. It doesn't work,'" Brawley says. "And, you know, in our racial categories, if we (categorize) all Asians together, it's very easy to see that people from Korea look different from people from India, but we call them all Asian. That's true, by the way, in Africa as well, we in the United States, perhaps have too much fog on our glasses to realize that people from Ghana can recognize people from Tanzania and can recognize people from Kenya. And there's some very big differences there."

In terms of racial profiling, and looking at prostate cancer, it is true that people who call themselves black have a higher incidence and higher death rate than those who call themselves white, he says.

In addition, it is also true the American Cancer Society established screening guidelines recommending informed decision making, where men know the potential risks and potential benefits of make a decision. For example, the ACS suggests that man of African heritage should consider screening at an earlier age perhaps 45 instead of 50, Brawley says.

He adds there are certain populations that should be screened for particular diagnoses and certain populations that should not get the screening.

Trump administration applying science
In regards to how the Trump administration is applying science and if it has done harm to the reputations of the FDA and CDC, Brawley is very concerned; especially on terms of the scientific method.

"I am more concerned that so many people in the United States don't understand science and don't understand the scientific method, than I am what the administration is trying to do," he explains. "The fact that (the administration) can do it is more of a concern to me than the fact that they are doing it. We have failed to teach people in grade school, onward, how to think and unfortunately, there's a whole large portion of our population who've been taught what to think, not how to think, and they don't appreciate science."