In a recent New England Journal of Medicine article, Bonham, et al, discuss the role of precision medicine (the use of genetic or molecular profiling to optimize the efficacy of medical drugs) and its potential to “replace the use of race in treatment decisions” (N Engl J Med 2016;374:2003-2005). Such decisions include the June 2005 FDA approval of the first pharmaceutical indicated for a specific race, which has been criticized for reinforcing a biological definition of race with the potential to support “a new biopolitics of race that threatens to make health and other social inequalities even worse” (Minn J Law Sci Technol 2011;12:1-21). While addressing the impact of race on outcomes is commendable, we would like to warn that improvements in prescribed medicine alone are not sufficient to address racial outcome disparities.
Particularly in cancer care, disparities persist in access to/quality of life-saving modalities such as surgery and radiation therapy even when patients receive comparable medical therapy. In brain cancer for instance, African-Americans have an adjusted relative risk for in-hospital mortality of 10.6 following acoustic neuroma surgery compared with Caucasians (J Neurooncol 2009;93:25-39). This increased mortality risk has also been found in extracranial tumors and is associated with African-Americans receiving diminished access to high-volume surgeons (J Neurooncol 2009;93:25-39, J Am Coll Surg 2006;203:787-794).
Sadly, regardless of cancer type/stage, barriers contributing to treatment modality disparities between population groups persist, abetting the 33 percent increased cancer mortality rate of African-Americans (J Natl Cancer Inst 2002;94:334-357). To truly move beyond race, access disparities to high-volume surgeons and radiation therapy must be addressed in concert with precision medicine restrained from being utilized in a manner similar to the 20th-century eugenics movement (J Am Med Inform Assoc 2016;23:782-786).
—Shearwood McClelland III, MD, Jerry J. Jaboin, MD, PhD, & Charles R. Thomas, Jr., MD, Oregon Health & Science University Portland