Skip to main content

Advertisement

SpringerLink
Log in

Addressing Breast Cancer Disparities by Improving Diversity of the Oncology Workforce

  • Breast Cancer Disparities (LA Newman, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

While breast cancer mortality continues to decline, improvements in survival have not been equal across racial and ethnic groups. Indeed, breast cancer mortality is estimated to be over 40% higher among Black women relative to White women. With socioeconomic and biological factors, structural racism, and access to care all implicated in breast cancer disparities, there has been increased attention given the diversity of the oncology workforce. The medical workforce, particularly in oncology, does not adequately represent this increasingly diverse population of the USA. This article explores the intersection of breast cancer disparities and diversity within the oncology workforce and offers insight into current initiatives designed to increase physician diversity and, in turn, breast cancer outcomes.

Recent Findings

Racial and gender diversity in the oncology workforce remains elusive. Yet, studies demonstrate that minority patients benefit from racially concordant care in terms of adherence, access to care, and higher quality of care.

Summary

Efforts need to be made to diversity the oncologic workforce to improve access and quality of care. Strategies such as mentorship, attention to bias, and efforts to reduce attrition at all levels of training along with policies and targeted interventions will help mitigate disparities and improve patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Cancer Society. Key statistics for breast cancer. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html. Published 2022. Accessed February 13, 2022.

  2. Surveillance Research Program NCI. SEER*Explorer: an interactive website for SEER cancer statistics. https://seer.cancer.gov/explorer/. Published 2022. Accessed February 13, 2022.

  3. DeSantis CE, Ma J, Gaudet MM, et al. Breast cancer statistics, 2019. CA Cancer J Clin. 2019;69(6):438–51.

    Article  Google Scholar 

  4. DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin. 2016;66(1):31–42.

    Article  Google Scholar 

  5. Pinheiro PS, Morris CR, Liu L, Bungum TJ, Altekruse SF. The impact of follow-up type and missed deaths on population-based cancer survival studies for Hispanics and Asians. JNCI Monogr. 2014;2014(49):210–7.

    Article  Google Scholar 

  6. Abraido-Lanza AF, Dohrenwend BP, Ng-Mak DS, Turner JB. The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses. Am J Public Health. 1999;89(10):1543–8.

    Article  CAS  Google Scholar 

  7. US Census Bureau. 2020 Census Redistricting Data (Public Law 94-171) Summary File. 2020. https://www.census.gov/data/datasets/2020/dec/2020-census-redistricting-summary-file-dataset.html. Accessed February 13, 2022.

  8. Association of American Medical Colleges. 2021 FACTS: enrollment, graduates, and MD-PhD data. https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data. Accessed Feburary 13, 2022.

  9. Liason Committee on Medical Education. Liaison Committee on Medical Education (LCME) standards on diversity. https://health.usf.edu/~/media/Files/Medicine/MD%20Program/Diversity/LCMEStandardsonDiversity1.ashx?la=en. Accessed February 13, 2022.

  10. Glazer G, Danek J, Michaels J, Bankston K, Fair M, Johnson S, Nivet M. Holistic admissions in the health professions: findings from a national survey. Washington, DC: Urban Universities for HEALTH; 2014.

    Google Scholar 

  11. Lett E, Murdock HM, Orji WU, Aysola J, Sebro R. Trends in racial/ethnic representation among US medical students. JAMA Netw Open. 2019;2(9):e1910490–e1910490.

    Article  Google Scholar 

  12. Boatright DH, Samuels EA, Cramer L, et al. Association between the Liaison Committee on Medical Education’s diversity standards and changes in percentage of medical student sex, race, and ethnicity. JAMA. 2018;320(21):2267–9.

    Article  Google Scholar 

  13. • Morris DB, Gruppuso PA, McGee HA, Murillo AL, Grover A, Adashi EY. Diversity of the national medical student body — four decades of inequities. N Engl J Med. 2021;384(17):1661–8. This study reports shifts in the demographics of US medical students from 1978 through 2019.

    Article  Google Scholar 

  14. Cropsey KL, Masho SW, Shiang R, Sikka V, Kornstein SG, Hampton CL. Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four-year results. J Womens Health. 2008;17(7):1111–8.

    Article  Google Scholar 

  15. Pololi L, Cooper LA, Carr P. Race, disadvantage and faculty experiences in academic medicine. J Gen Intern Med. 2010;25(12):1363–9.

    Article  Google Scholar 

  16. Price EG, Powe NR, Kern DE, Golden SH, Wand GS, Cooper LA. Improving the diversity climate in academic medicine: faculty perceptions as a catalyst for institutional change. Acad Med. 2009;84(1):95–105.

    Article  Google Scholar 

  17. Price EG, Gozu A, Kern DE, et al. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med. 2005;20(7):565–71.

    Article  Google Scholar 

  18. Rodriguez JE, Campbell KM, Mouratidis RW. Where are the rest of us? Improving representation of minority faculty in academic medicine. South Med J. 2014;107(12):739–44.

    Article  Google Scholar 

  19. West MA, Hwang S, Maier RV, et al. Ensuring equity, diversity, and inclusion in academic surgery: an American Surgical Association white paper. Ann Surg. 2018;268(3):403–7.

    Article  Google Scholar 

  20. Osseo-Asare A, Balasuriya L, Huot SJ, et al. Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Netw Open. 2018;1(5):e182723.

    Article  Google Scholar 

  21. Baldwin DC Jr, Rowley BD, Daugherty SR, Bay RC. Withdrawal and extended leave during residency training: results of a national survey. Acad Med. 1995;70(12):1117–24.

    Article  Google Scholar 

  22. DeCastro R, Griffith KA, Ubel PA, Stewart A, Jagsi R. Mentoring and the career satisfaction of male and female academic medical faculty. Acad Med. 2014;89(2):301–11.

    Article  Google Scholar 

  23. Berry C, Khabele D, Johnson-Mann C, Henry-Tillman R, Joseph KA, Turner P, Pugh C, Fayanju O, Backhus L, Sweeting R, Newman E, Oseni T, Hasson R, White C, Cobb A, Johnston F, Stallion A, Karpeh M, Nwariaku F, Rodriguez LM, Hayes-Jordan A. A call to action: Black/African American women surgeon scientists, where are they? Ann Surg. 2020;272(1):24–9.

    Article  Google Scholar 

  24. • Crown A, Berry C, Khabele D, et al. The role of race and gender in the career experiences of Black/African American academic surgeons: a survey of the society of Black academic surgeons and a call to action. Ann Surg. 2021;273(5):827–31. This manuscript reports survey outcomes among Black academic surgeons and discusses barriers to promotions and strategies to improve recruitment and retention as well as leadership opportunities for URM and women surgeons.

    Article  Google Scholar 

  25. Schroen AT, Brownstein MR, Sheldon GF. Women in academic general surgery. Acad Med. 2004;79(4):310–8.

    Article  Google Scholar 

  26. Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority physicians’ role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med. 2014;174(2):289–91.

    Article  Google Scholar 

  27. Komaromy M, Grumbach K, Drake M, et al. The role of Black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334(20):1305–10.

    Article  CAS  Google Scholar 

  28. Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273(19):1515–20.

    Article  CAS  Google Scholar 

  29. Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008;300(10):1135–45.

    Article  CAS  Google Scholar 

  30. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004.

    Article  CAS  Google Scholar 

  31. Saha S, Taggart SH, Komaromy M, Bindman AB. Do patients choose physicians of their own race? Health Aff (Millwood). 2000;19(4):76–83.

    Article  CAS  Google Scholar 

  32. Schoenthaler A, Montague E, Baier Manwell L, Brown R, Schwartz MD, Linzer M. Patient-physician racial/ethnic concordance and blood pressure control: the role of trust and medication adherence. Ethn Health. 2014;19(5):565–78.

    Article  Google Scholar 

  33. Shen MJ, Peterson EB, Costas-Muniz R, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities. 2018;5(1):117–40.

    Article  Google Scholar 

  34. Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002;43(3):296–306.

    Article  Google Scholar 

  35. Corbie-Smith G, Thomas SB, Williams MV, Moody-Ayers S. Attitudes and beliefs of African Americans toward participation in medical research. J Gen Intern Med. 1999;14(9):537–46.

    Article  CAS  Google Scholar 

  36. Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Arch Intern Med. 2002;162(21):2458–63.

    Article  Google Scholar 

  37. Branson RD, Davis K, Butler KL. African Americans’ participation in clinical research: importance, barriers, and solutions. Am J Surg. 2007;193(1):32–9.

    Article  Google Scholar 

  38. •• Kamran SC, Niemierko A, Deville C Jr, Vapiwala N. Diversity trends by sex and underrepresented in medicine status among US radiation and medical oncology faculty over 5 decades. JAMA Oncol. 2022;8(2):221–9. This cross-sectional study reports demographic trends in the makeup of medical and radiation oncology faculty in academic departments.

    Article  Google Scholar 

  39. McClelland S 3rd, Huang CC, Griffith KA, Shan M, Holliday EB, Jagsi R, Zellars RC. Composition of the current academic radiation oncology workforce in comprehensive cancer centers. JCO Oncol Pract. 2022;18(5):e740–7. https://doi.org/10.1200/OP.21.00609.

    Article  Google Scholar 

  40. Deville C Jr, Cruickshank I Jr, Chapman CH, et al. I can’t breathe: the continued disproportionate exclusion of Black physicians in the United States radiation oncology workforce. Int J Radiat Oncol Biol Phys. 2020;108(4):856–63.

    Article  Google Scholar 

  41. Butler PD, Longaker MT, Britt LD. Major deficit in the number of underrepresented minority academic surgeons persists. Ann Surg. 2008;248(5):704–11.

    Article  Google Scholar 

  42. Yu AYL, Iwai Y, Thomas SM, Beasley GM, Sudan R, Fayanju OM. Diversity among surgical faculty, residents, and oncology fellows from 2011/2012 to 2019/2020. Ann Surg Oncol. 2022;29(5):2763–5. https://doi.org/10.1245/s10434-021-11170-z.

    Article  Google Scholar 

  43. Keshinro A, Butler P, Fayanju O, Khabele D, Newman E, Greene W, Ude Welcome A, Joseph KA, Stallion A, Backhus L, Frangos S, DiMaggio C, Berman R, Hasson R, Rodriguez LM, Stain S, Bukur M, Klein MJ, Henry-Tillman R, Barry L, Oseni T, Martin C, Johnson-Mann C, Smith R, Karpeh M, White C, Turner P, Pugh C, Hayes-Jordan A, Berry C. Examination of intersectionality and the pipeline for black academic surgeons. JAMA Surg. 2022;157(4):327–34. https://doi.org/10.1001/jamasurg.2021.7430.

    Article  Google Scholar 

  44. Yuce TK, Turner PL, Glass C, Hoyt DB, Nasca T, Bilimoria KY, Hu YY. National evaluation of racial/ethnic discrimination in US surgical residency programs. JAMA Surg. 2020;155(6):526–8. https://doi.org/10.1001/jamasurg.2020.0260.

    Article  Google Scholar 

  45. DeCastro R, Sambuco D, Ubel PA, Stewart A, Jagsi R. Mentor networks in academic medicine: moving beyond a dyadic conception of mentoring for junior faculty researchers. Acad Med. 2013;88(4):488–96.

    Article  Google Scholar 

  46. Quiroga E, Gonzalez A, Newhall K, Shalhub S. Understanding and finding opportunities for inclusive mentorship and sponsorships in vascular surgery. J Vasc Surg. 2021;74(2s):56s–63s.

    Article  Google Scholar 

  47. Newman EA, Waljee J, Dimick JB, Mulholland MW. Eliminating institutional barriers to career advancement for diverse faculty in academic surgery. Ann Surg. 2019;270(1):23–5.

    Article  Google Scholar 

  48. Coleman DM, Dossett LA, Dimick JB. Building high performing teams: opportunities and challenges of inclusive recruitment practices. J Vasc Surg. 2021;74(2s):86s–92s.

    Article  Google Scholar 

  49. • Butler PD, Aarons CB, Ahn J, et al. Leading from the front: an approach to increasing racial and ethnic diversity in surgical training programs. Ann Surg. 2019;269(6):1012–5. This manuscript details a three-faceted approach to increasing diversity in the University of Pennsylvania surgical training programs and reports outcomes following implementation of the approach.

    Article  Google Scholar 

  50. Asch DA, Grischkan J, Nicholson S. The cost, price, and debt of medical education. N Engl J Med. 2020;383(1):6–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Breast Surgery, True Family Women’s Cancer Center, Swedish Cancer Institute, Seattle, WA, USA

    Angelena Crown

  2. Department of Surgery, New York University Grossman School of Medicine, Kimmel Pavilion, 424 East 34th Street, New York, NY, USA

    Kathie-Ann Joseph

  3. NYU Langone Health’s Institute for Excellence in Health Equity, 180 Madison Avenue, New York, NY, USA

    Kathie-Ann Joseph

Authors
  1. Angelena Crown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathie-Ann Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathie-Ann Joseph.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Breast Cancer Disparities

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crown, A., Joseph, KA. Addressing Breast Cancer Disparities by Improving Diversity of the Oncology Workforce. Curr Breast Cancer Rep 14, 162–167 (2022). https://doi.org/10.1007/s12609-022-00456-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-022-00456-0

Keywords

Search

Navigation