Racial Disparities in Patients with Bladder Cancer

Shaakir Hasan, DO, an oncologist at New York Proton Center, discusses for potential reasons for continuing racial disparities in bladder cancer despite years of evidence of the issue.

According to Hasan, there are a couple questions to ask when considering this question. The first is that certain races have a predilection to having a more aggressive disease. However, all other factors should be taken into consideration before this is the conclusion.

For example, in prostate cancer, African Americans tend to have more aggressive disease. This should be taken into account when planning treatment. However, when race is isolated, there isn’t much of a difference in outcomes. The more aggressive disease seen in African American patients may be more related to health disparities. According to Hasan, it might be the same here.

0:08 | The "why" is going to be speculative, so let's start with that. The “why” we would say this is that we have to consider everything. We don't want to jump to conclusions, and we have to explore. It is very important to ask that question and dive in and try to figure it out.

0:18 | We do see some disease sites that certain races have a predilection to maybe having more aggressive disease. But then we can always kind of re-examine those cases and find that might not be the case.

0:32 | As an example, I treat a lot prostate cancer. In prostate cancer, we've traditionally learned that African Americans have more aggressive disease. We still keep that in the back of our mind when we think of treatment options. But if you look at a lot of the work being done more recently, if we control for everything else, and just isolate the race, there isn't a difference. It might be that the outcome is more related to health disparities and access to health care when they were diagnosed, the treatment that they received. That might be a greater explanation as to why we see these differences in outcome, and the same might be here.

1:20 | In the older SEER study that I mentioned, they pointed out that African Americans tend to have a higher-grade disease, meaning more aggressive disease at the outset. And so, they were saying that might be a possibility, maybe just naturally, with the race. You have a higher degree of aggressiveness and that's why you catch it later, and it has nothing to do with health care disparities or things like that. We did control for that and made sure to isolate the grade and factored into our model that we use here.

2:00 | We still saw a considerable discrepancy when it when it comes to a diagnosis and outcomes for African Americans. But I just wanted to use that as an example, that there could be some clinical factors, things we don't know about that we can't control for in these models that can explain some of these discrepancies that may not be related to actual access to health care or quality of care, etc. We also have to definitely look at the mirror and look at the healthcare system itself and say, okay, whatever the cause is, something's not right here there is an equity that we have to address. We have to look at ourselves, look at the clinical factors, but also look at ourselves to figure out what we can do about it.