The Role of Education in the Underdiagnosis of Skin Cancer in African Americans
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Hope Buchan
CoPIs:
Kari Milch, Kaitlyn McTernan, Laura Spiak, Nicole Vassallo
College:
The College of Health Professions and Human Services
Major:
Physician Assistant Studies (M.S.)
Faculty Research Advisor(s):
Wendy Ritch
Abstract:
Introduction:
Skin cancer is statistically more common in Caucasians than African Americans, which in turn has led to an underrepresentation of how skin cancer appears in African Americans in textbooks and other educational materials. Previous research has found evidence to suggest that socioeconomic factors, lack of access to healthcare, the presence of bias, and deficient skin cancer education among non-White populations as well as lack of physician training may contribute to the disparity in African American skin cancer mortality rates (Rizvi Z, Kunder V, Stewart H, et al., 2022).
Objective:
The purpose of the proposed research is to determine whether skin cancer diagnosis is delayed in African Americans compared to Caucasians due to lack of examples provided during medical education and how this affects patient outcomes. It is hypothesized that a lack of education on how skin cancer presents in African Americans, leads to a delay in diagnosis in these patients and therefore poorer health outcomes when compared to Caucasians.
Methods:
To explore this claim, a survey was sent to all physician assistant programs in the United States and additional medical and nurse practitioner programs. The survey was disseminated via existing networks, emails to program directors to distribute to students, and social media via Instagram. The survey was completed anonymously by human subjects (N=376) through Qualtrics and asked questions aimed at evaluating their knowledge regarding how skin cancer presents in African Americans and diagnosis within this population.
Results:
We found that 239 (63.6%) of those surveyed responded that their medical training did include different presentations of skin cancer in different populations, and skin colors. When looking at whether respondents were aware of what skin cancer looks like 314 (83.5%) said they are aware of what it looks like in a Caucasian person and 204 (54.2%) said they are aware of what it looks like in African Americans. Comparing those who were confident in diagnosing skin cancer 214 (56.9%) said definitely or probably yes to feeling prepared in diagnosing a Caucasian person versus 71 (18.9%) who feel prepared to diagnose African Americans. We did find that many respondents who said they know what skin cancer looks like in African Americans also reported having previous clinical experience in a dermatology setting. Ultimately our results show that the majority of students are being taught about what skin cancer looks like in different populations, but they are not confident when it comes to diagnosing.
Conclusion:
Given the importance of early diagnosis of skin cancer for increased patient outcomes, more research is needed to better understand the impact medical education has on the diagnosis of skin cancer in African American patients.