Spring 2018

Archives

It’s a sobering thought: that your chances of surviving cancer might depend on your race.

Yet that’s the reality for many African-American women with endometrial cancer. Black women have a 55-percent higher mortality rate after diagnosis than other groups of women. And understanding why means asking some hard questions about health equity.

“It’s fascinating how much history you learn in medical school,” says Kemi Doll, M.D., MSCR, UW assistant professor in the Department of Obstetrics and Gynecology. But that history generally doesn’t include the legacy of institutional racism and its effects on patient care — and without that context, Doll argues, it’s hard for doctors to address health equity.

“We don’t learn the ways in which medicine has had all of these wrong ideas about race, and therefore we’re not able to develop that kind of questioning muscle in ourselves — and without that, you don’t get creative about solutions,” she says.

Doll knew from a young age that she wanted to be a doctor, but it wasn’t until her residency at Northwestern University’s Feinberg School of Medicine that she decided to specialize in gynecologic oncology.

“I loved connecting to the patients, the intensity of the relationships. Gynecological cancer is about the woman’s entire relationship with her reproductive life,” says Doll. “I couldn’t imagine anything else that would be as rewarding and nourishing to my spirit.”

Yet her experiences as a resident at Chicago hospitals revealed a stark imbalance in how patients of different backgrounds are treated. “The systems can be so different for people, even though the diseases are the same,” says Doll. “It influences everything about a woman’s experience: symptoms, care, delivery and outcomes.”

After medical school, Doll earned a master’s degree in clinical research through a postdoctoral research fellowship in cancer care quality at the University of North Carolina. While analyzing Medicare and Medicaid populations, Doll noticed major disparities in patient outcomes that weren’t attributable to insurance coverage.

She found the largest disparity in uterine cancer. Most women with endometrial cancer — the most common type of uterine cancer — are diagnosed at an early stage and are treated effectively, leading to an overall five-year survival rate of over 80 percent. However, African-American women across every educational and income level have a much lower chance of receiving that critical early diagnosis, resulting in thousands of preventable deaths each year.

“Endometrial cancer is the most common gynecologic cancer; 1 in 37 women get it,” says Doll. “But there’s not a single study where we’ve even talked to Black women about their experiences with it, and how their experiences may differ from everyone else’s.”

Five Years Out

Race matters to survival in the U.S. Five years after diagnosis, more Black women than White will die of endometrial cancer.

Mortality Rate of Black Women

Mortality Rate of White Women

Doll joined UW Medicine with an innovative strategy for eliminating the racial mortality gap in endometrial cancer. Her 360-degree approach tackles the problem on multiple fronts: healthcare delivery, patient education, provider training and, importantly, community partnership.

Part of bringing women’s voices into cancer care means listening to patients tell their stories. To achieve this goal, Doll is partnering with Bridgette Hempstead, who has led a Seattle-based African-American breast cancer support group called Cierra Sisters for 20 years.

“It was important to me to have a member of the community represented in my work,” says Doll. “We have this wonderful partnership where she is doing the patient interviews, and the data coming out is just so much richer.”

Advocacy is integral to Doll’s approach. She is developing the Endometrial Cancer Action Network for African-Americans (ECANA), an organization that will unite cancer survivors, researchers, clinicians and healthcare advocates to collaborate on treating endometrial cancer. Doll envisions it as a hub for patients to connect with each other and with researchers, breaking down the historical walls of distrust and distance.

“There has been no voice for these women,” says Doll. “And yet they are here, ready to partner and ready to understand what’s going on.”

Let’s pull out the things that are impacting this community negatively — the areas of ignorance and bias — and build solutions.

Margie Willis is one of those women. She was diagnosed with endometrial cancer in 2016 and saw Doll for chemotherapy. After her treatment was complete, she joined ECANA as a patient advocate. “She was like a breath of fresh air,” says Willis. “Dr. Doll wants to get ideas, information and thoughts from actual patients. That’s why I was excited to be part of her research.”

Doll’s work at UW Medicine is just beginning, and eventually, she hopes to close the gap in racial disparities in endometrial cancer. In time, she wants to create a model for improving health equity in other areas of care, too. “The concepts and approaches are universally applicable,” she says.

“There’s so much to be done to educate the research community about how we deal with issues of race and racial discrimination, and how we study these kinds of health outcomes,” says Doll. “Let’s pull out the things that are impacting this community negatively — the areas of ignorance and bias — and build solutions.”

Share

Related Stories

In Their Shoes

Caseworkers advocate for their communities.