A panel convened by the Cancer History Project for Black History Month started with a discussion of mentorship, and concluded with a big underlying concept—justice.
The panel, which met Feb. 23 at 7 p.m., included:
- Robert A. Winn, MD
Guest editor, Cancer History Project;
Director and Lipman Chair in Oncology, VCU Massey Cancer Center;
Senior associate dean for cancer innovation and professor of pulmonary disease and critical care medicine, VCU School of Medicine - Otis W. Brawley, MD
Co-editor, Cancer History Project;
Bloomberg Distinguished Professor of Oncology and Epidemiology, Johns Hopkins University - Edith P. Mitchell, MD
Member, President’s Cancer Panel;
Clinical professor of medicine and medical oncology,
Department of Medical Oncology;
Director, Center to Eliminate Cancer Disparities;
Associate director, diversity affairs;
Sidney Kimmel Cancer Center at Jefferson, Thomas Jefferson University - John H. Stewart, MD, MBA
Professor of surgery, Section of Surgical Oncology;
Founding director, LSU Health/LCMC Health Cancer Center
Words matter, Mitchell said, focusing on the oft-used euphemistic expression “implicit bias.”
“There’s no such thing as ‘implicit bias.’ If somebody can look at you and based on your color or your gender or some other aspect—that’s not implicit. That’s racism,” Mitchell said.
“It is well recognized that Black patients in a majority situation receive fewer minutes during a clinical consultation than white patients. That’s not implicit. That is a person making a decision based on other attributes of the patient’s physique—the color, maybe even what they’re wearing, how they speak, and other facets that are related to the individual patient,” she said.
The expression “health disparities” also merits unpacking, Stewart said.
“Let’s think about what the definition of disparities really is. We understand it’s access—or lack of access—to really good care, but the double edged sword of that is that it is also exposure to less effective care. So, more ineffective care, less effective care,” Stewart said. “We have to address both of those issues if we’re really going to understand health equity and how we move forward with health equity.”
Tackling health disparities means addressing the many factors —structural, social, and even epigenetic—that create them.
“I think that where we go often is the biology, thinking that African Americans are just more predisposed by their biology to having cancer, as opposed to the structures that have created many of those disparities,” Winn said. “We can’t talk about the treatment and the biological differences without understanding the structural issues. I’ve been going around talking about the ZNA or the znome, the ZIP code of association, and how that ZNA actually impacts the DNA and your ultimate biology.”
The panelists said mentorship was crucial to their career development.
“I remember when I started at the University of Chicago in 1981, they had one Black full professor in the medical school. It happened to be Jim Bowman, who is now famous as Valerie Jarrett’s father,” Brawley said. “He was the only Black full professor in the medical school at the University of Chicago in the early 1980s.”
Howard University was the first place Stewart found mentors who looked like him.
“That made all of the difference in the world, because I actually was at an institution where people looked like me and we emulated excellence,” Stewart said. “When I say emulate excellence, LaSalle D. Leffall was the chair of surgery there. We all wanted to be like LaSalle D. Leffall. I think that many of his habits still resonate with me today.”
The panelists said the communities they grew up in have informed their careers in oncology, driving them to focus on underserved populations.
“It was clear to me that the reality is that I wasn’t just going to school for me to become a doctor, I was not just going to school for me just to graduate, but I was going to school for me to have a purpose,” Winn said. “The focus on the health disparities and the focus on trying to reduce that gap was by John and Hannah Darden, my grandparents, who ultimately told me, ‘Don’t go to school and start learning all the books and then become stupid enough not to know that you need to go back to your community and help.’”
Stewart, too, said his background better informs his approach to medicine.
“A year ago, when I had the opportunity to come back to my home state to found a cancer center in New Orleans, it was an opportunity that I could not pass up, because as you know, in Louisiana, we have such disparate outcomes in cancer, if you look at racial and ethnic differences, if you look at rural and urban differences in outcomes, if you look at outcomes in the Delta—we’ve got a real opportunity to affect change,” Stewart said. “So, not only giving back to my community, but also giving back to the spirit of those who have poured so much in me over my career has been a singular professional honor.
“Multi-level interventions based upon improving implicit bias, multi-level interventions based upon understanding some of the structural barriers to care, are even more evident in surgery. So, that’s really what has driven me, and I still live to this day to think that, A, you have to help the community, B, you have to ask the right question, but that right question needs to be informed by the community so that your findings are relevant to their everyday lives.”
The conversation is available as a video and podcast.
