Hispanic ethnicity often not reported in breast cancer studies
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Fewer than half of breast cancer studies in the National Cancer Database reported Hispanic ethnicity and about one-third categorized race and ethnicity into mutually exclusive groups, according to study results.
The findings, published in JAMA Oncology, additionally showed that less than 1% of studies disaggregated ethnoracial categories for Hispanic and non-Hispanic individuals.
Background
Hispanic individuals comprise 18.7% of the U.S. population and represent the fastest growing demographic in the U.S., according to U.S. Census Bureau data.
“Despite this, the inclusion of Hispanic ethnicity as a covariate in studies is inconsistent, and disaggregation of Hispanic ethnicity by race is infrequent,” Jose G. Bazan, MD, MS, radiation oncologist in the department of radiation oncology at The Ohio State University Comprehensive Cancer Center, and colleagues wrote. “For patients with breast cancer, studies suggest that there are ethnoracial (eg, Hispanic-Black, Hispanic-white) differences in stage, treatment and mortality.”
Bazan and colleagues sought to characterize the inclusion of Hispanic ethnicity or ethnoracial categories in 361 breast cancer studies with a median sample size of 68,242 patients included in the National Cancer Database between 2010 and 2021.
Findings
Results showed 36% of studies reported mutually exclusive race and ethnicity groups, including Hispanic, non-Hispanic Black and non-Hispanic white, in the patient demographics, and 32% of studies reported them in the results. Moreover, only two studies disaggregated Hispanic ethnicity by race.
Reporting of ethnicity occurred less frequently compared with race in the patient demographics (47% vs. 87%), the results (42% vs. 80%) and both the patient demographics and results (41% vs. 79%) of studies, and was more likely to not be reported in either the patient demographics or results (52% vs. 12%).
Implications
“These results are meaningful when contextualized within the race and ethnicity reporting guidance from JAMA,” Bazan and colleagues wrote.
“Future studies should categorize patients by both race and ethnicity and report country of origin when available,” they continued. “The inclusion of distinct ethnoracial categories will further improve the understanding of the influence of ethnoracial differences in experiences of systemic inequity, structural racism, and discrimination, as well as their effects on breast cancer outcomes.”
Racism in biomedical research contributes substantially to race-based medicine, according to an accompanying viewpoint by Odeth Barrett-Campbell, MD, hematologist-oncologist at Dartmouth Cancer Center, Maya DeGroote, MD, primary care physician at Contra Costa Family Medicine Residency in California, and Frederick Lansigan, MD, interim associate dean of diversity, equity and inclusion at Geisel School of Medicine at Dartmouth Hitchcock Medical Center.
“Race is a social power construct that has been wrongly used as a proxy for genetic variation despite demonstrated genetic heterogeneity within racial groups,” they wrote. “It is critical to assess how race and ethnicity are categorized and used in cancer research. To mitigate health inequities, cancer studies should use ‘race-conscious medicine’ that ‘emphasizes [structural] racism, rather than race, as a key determinant of illness and health.’”
References :
- Barrett-Campbell O, et al. JAMA Oncol. 2022;doi:10.1001/jamaoncol.2022.2841.
- Bazan JG, et al. JAMA Oncol. 2022;doi:10.1001/jamaoncol.2022.3527.
Perspective
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Tiffany Onger, MD
Bazan and colleagues explored the frequency at which ethnoracial data was reported in a cohort of breast cancer studies identified in the National Cancer Database. The researchers found that Hispanic ethnicity is reported in fewer than 50% of studies, and approximately one-third of the studies categorized race into mutually exclusive groups.This is particularly troubling given what we know about cancer biology and the effect that genetics can play in the behavior of a tumor. As oncologists, we are tasked with determining whether the results of a particular study apply to the patient in our office. The patient demographics help us answer this question but, when the data is incomplete — either by not including race or ethnicity at all, or by categorizing race into mutually exclusive groups — it becomes more difficult to say with certainty whether the results of the study are applicable to a given patient.
This is not to say that ethnoracial data tells us the whole story. This is because “race” is a social construct and is not a reliable replacement for detailed genetic studies. The race of a person may vary depending on the country that they are in when being identified or identifying themselves.
“Ethnicity” is similarly challenged and may confer more information about cultural belonging than genetic similarity, especially in a population as diverse as the Hispanic populace. This is further complicated because “Hispanic” does not necessarily confer a particular race. There are Afro-Latinos, people who have African ancestry, and who speak Spanish as their native language and identify with Hispanic (or more recently “Latinx” or “Latine”) culture, and identify as “Black”. This is an example of intersectionality of race — Black race in this case — and Hispanic ethnicity.
The findings of this study pose an opportunity for us as a medical community to hold ourselves to a higher standard. It challenges us to conduct studies to be as diverse as our patients, and to report it in a way that can allow our patients to be seen.
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