Healthcare disparities are not new.
For decades, many people have systematically experienced obstacles to health and healthcare based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, physical disability, sexual orientation, gender identity, geographic location, or other characteristics historically linked to discrimination and exclusion.
These disparities reflect longstanding structural and systemic inequities but have recently been exacerbated by the COVID-19 pandemic. And nowhere is this more noticeable than in cancer management.
Several years ago, one of the world’s leading scientific publications, The New England Journal of Medicine, reported on ongoing racial disparities in the treatment of breast cancer in the US.
In fact, although more white women in general get breast cancer in the US, black women were 40 per cent more likely to die from it. Scientists feel that some reasons for this include less access to screening mammograms, less access to therapy, as well as being diagnosed at a later stage. Moreover, researchers found that black women have a much higher risk of having their cancer spread, or metastasise, which is a major cause of death in breast cancer. These women were actually six times more likely to develop distant tumours than white women.
Of course, although healthcare is essential to health, research shows that health outcomes are driven by multiple factors, including underlying genetics, health behaviours, social and environmental factors, and access to healthcare. Tumour biology and aggressiveness also play a role.
Having said that, many of these problems have been compounded by COVID-19 and apply to other diseases. During the height of the COVID-19 pandemic, many elective tests and procedures were stopped in order to reduce patient exposure and redeploy medical personnel.
These elective tests included screening for several cancers—breast cancers with mammography, cervical cancer with Pap smear, colon cancers with colonoscopies and skin cancers with routine dermatologic exams.
Multiple studies have reported substantial reductions in the rate of screening mammograms during the pandemic shutdown period in 2020, with mammograms falling between 40 to 90 per cent of their usual volume during that period.
In the US again, this translated into an absolute deficit in breast cancer screening of almost four million people in 2020 compared with 2019. Hence, the more recent finding of increased cases of late-stage breast cancer once pandemic restrictions were removed.
It now seems like a tremendous uphill battle to ensure the backlog due to COVID-19 delays is addressed, while allowing for the already established disparities that exist in healthcare delivery.
These gaps in care are now widened, particularly when you look at the lack of access to care, the uninsured versus the insured, the huge burden of disease, mental health challenges, and other inequalities that exist.
Personally, I have already seen more than the usual number of gynaecological cancer diagnoses from women who have omitted their usual check-ups and screening tests over the past several years.
It is crucial that we all recognise there is only so long you can put off these assessments that aim to prevent or, at best, pick up something early. Equally important is recognising our own health disparities, as narrowing these gaps are key to improving our nation’s overall health and reducing unnecessary healthcare costs.
