Does veteran status mitigate racial and ethnic disparities in cancer screening? A comprehensive analysis of Prostate, Colorectal, Breast, and Cervical cancer screening among veterans and non-veterans using the United States Behavioral Risk Factor Surveillance System.

Abstract

In the United States, racial/ethnic minorities have been associated with worse outcomes for many chronic diseases, ranging from cardiovascular conditions to cancer. Indeed, the cancer literature is replete with such findings in breast, colon, and prostate cancers. Historically, the racial/ethnic gap in cancer outcomes were believed to be attributed to biology, anthropology, and genetics. But in fact, race is a complex classification that has been socially, politically, and legally constructed over the past 5 centuries. Therefore, race is not an accurate representation of human biological variation. As a result, several scientific and medical organizations have issued policy statements recognizing race as a social construct, rather than a biological one, stressing that it does not have biological underpinnings. Indeed race, through racism, has real biological consequences. Racism is complex and pervasive, it operates at multiple interrelated levels, and exerts negative effects on other social determinants, health, and well-being through multiple pathways. Once established being at the causal pathway of a disease, it posits a vicious cycle of social disadvantage, marginalization, and health disparities. Understanding the barriers and mechanisms by which differences in race and ethnicity and racism can affect health, and their determinants, is a prerequisite to finding solutions to achieve greater health equity. Emerging evidence suggests that racial and ethnic disparities can be mitigated by providing equitable access and improved health coverage along the continuum of cancer care. In this thesis project, we challenged these evidence by examining whether an augmented improved health coverage available to veterans can lead to equitable utilization of cancer screening services among racial and ethnic minorities. We thought of veteran status as a proxy to study the effect of enhanced augmented health coverage on the uptake of cancer screening. We thus examined whether veteran status mitigates racial disparities in prostate, colorectal, breast, and cervical cancer screening. We hypothesized that veteran status mitigates differences in utilization of cancer screening among racial and ethnic minorities relative to White patients.