Scientia Pro Publica is EPIC [The Primate Diaries]

The twice monthly premiere science blog carnival has just been posted at Mauka to Makai. Many of your favorite science bloggers have been included (as well as yours truly). Make sure to stop in and prepare to be amazed.

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Also check out the featured ScienceBlog of the week: Neurotopia

See original: ScienceBlogs Select Scientia Pro Publica is EPIC [The Primate Diaries]

Cameron Neylon: Nearly final version of collaborative proposal for a lightweight data management framework for submission in next few days.

Cameron Neylon
Nearly final version of collaborative proposal for a lightweight data management framework for submission in next few days.
Allyson Lister, Claudia Koltzenburg, Steve Koch and 5 other people liked this
Crud - sorry for the re-post folks, there was something in that version that shouldn't have been (and if anyone's downloaded the file and figured out what it is I'd appreciate it if you didn't spread it around - some details to be ironed out yet) - Cameron Neylon
That's had various bits taken out of it, specifically support from commercial partners and the financial details, as well as the names of suggested referees. - Cameron Neylon
....and its gone! - Cameron Neylon

See original: FriendFeed - search Cameron Neylon: Nearly final version of collaborative proposal for a lightweight data management framework for submission in next few days.

Do the New Breast Cancer Guidelines Discriminate Against Women of Color? [On Becoming a Domestic and Laboratory Goddess]

I am going to take a break for a few days from answering emails. I've got some posts of a scientific nature I would like to get to. But, if you're waiting in the queue, don't fret. I will get back to answering emails soon.

This morning I was driving to work and listening to NPR when I heard a story about the new guidelines for breast cancer screening, created by the U.S. Preventive Services Task Force (USPSTF). In brief, in November the USPSTF released recommendations for breast cancer screening. They updated the recommendations on December 4th so that they now state the following:

  • The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms: Grade: C recommendation.

I was a bit struck by the new verbage of the recommendation for women less than 50 years old, because there seems to be a disconnect.  You see, the vice chair of the committee, Dr. Diana Petitti said with regards to the recommendation, "So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether mammography is right for you based on your family history, general health, and personal values." However, a Class C recommendation means, "The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small. Offer or provide this service only if other considerations support the offering or providing the service in an individual patient."  I fear that insurance companies are going to hear the more strongly worded "Class C recommendation" and ignore the woman-appeasing overtones of Dr. Petitti's statement.  But, I digress...

The NPR story specifically discussed the impact of these new guidelines on black women.  You see,  although white women have a higher risk of developing breast cancer throughout their lifetime, black women are at a higher risk for developing cancer before 40, they are more likely to have large undiagnosed tumors, and they are more likely to have aggressive, resistant cancers.  Finally, the 5 year survival rate for a white woman is 90%, while the survival rate for a black woman is only 78% (additional statistics can be found here). 

Indeed, there are interacting environmental, potentially genetic, and socioeconomic factors that impact women of color differently from their white counterparts.  Nick Kristof wrote an interesting piece in the New York Times on Saturday about the potential effect of environmental pollutants on cancer development.  In his article he noted the earlier development of cancers in women and that:

...the risk that a 50-year-old white woman will develop breast cancer has soared to
12 percent today, from 1 percent in 1975. (Some of that is probably a result of
better detection.) Younger people also seem to be developing breast cancer: This
year a 10-year-old in California, Hannah, is fighting breast cancer and
recording her struggle on a blog.

If there is an environmental modifier, originating from man-made pollution, then the effects of the modifier should be seen more profoundly in non-white women who experience a larger pollution burden, frequently as a result of differences in socioeconomic status.   This means specifically that if there is an environmental modifier that causes women to develop cancers earlier,  women of color will experience it more than white women.   I wonder, if we stop screening these women, if we will more frequently miss cancers in this particular group of women. 

The other thing I wonder about is the effect these recommendations will have on the perception of health care equity.  A black woman is more likely to develop aggressive cancer than a white woman before age 50, yet the USPSTF has recommended not to actively screen women less than.   I wonder how this will be interpreted by that community?  Black women experience a distrust of scientists performing clinical trials (second reference here), operate within a healthcare that is not always sensitive to their needs, and use mammography as a resource less frequently than white women.  Will these new recommendations foster feelings of distrust and reinforce the notion that the current health care system does not adequately meet their needs?

In their recommendations, the USPSTF makes the following statement under the "Research Needs and Gaps" heading:

Better understanding of certain facets of tumor biology is needed, particularly
how age, race, breast density, and other factors may predispose certain women
toward tumors with faster growth rates and greater lethality. This would improve
the ability to determine at diagnosis which patients can be treated minimally.

But, they make no statement about women of color under the "Burden of Disease" heading.  I see no evidence that this group specifically evaluated the impact of their recommendations on this group in their risk assessment modeling, or considered the implications.  It seems to me that one of two things has happened - 1) The USPSTF did not consider ethnicity as a factor in making their recommendations or 2) The USPSTF did consider ethnicity, deemed to it be unimportant, but failed to clarify specifically why these new recommendations apply to this at higher risk group.

Either way, I am left concerned about the impact these recommendations are going to have on women of color.

 

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Also check out the featured ScienceBlog of the week: Neurotopia

See original: ScienceBlogs Select Do the New Breast Cancer Guidelines Discriminate Against Women of Color? [On Becoming a Domestic and Laboratory Goddess]