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1/
How did #endometriosis get labeled a “white woman’s disease”?
Let’s explore a great paper by @DrSonySinghMD in @AJOG
https://www.ncbi.nlm.nih.gov/pubmed/30738028
How did #endometriosis get labeled a “white woman’s disease”?
Let’s explore a great paper by @DrSonySinghMD in @AJOG
https://www.ncbi.nlm.nih.gov/pubmed/30738028
2/
First, a quick survey.
Women with endometriosis are most commonly:
First, a quick survey.
Women with endometriosis are most commonly:
3/
If you were to google "endometriosis patient"...this is what you get. ALL. WHITE. WOMEN.
Now why is that? Let's take a deep dive in their article
If you were to google "endometriosis patient"...this is what you get. ALL. WHITE. WOMEN.
Now why is that? Let's take a deep dive in their article
4/
1921: Sampson describes condition by noting ectopic endometrium
1938: Meigs links #endometriosis to contraceptive use & delayed childbearing
Fertility pattern more common among the “well to do” he thought
"Endo is a lifestyle disease of white upper middle class women"
1921: Sampson describes condition by noting ectopic endometrium
1938: Meigs links #endometriosis to contraceptive use & delayed childbearing
Fertility pattern more common among the “well to do” he thought"Endo is a lifestyle disease of white upper middle class women"
5/
Meigs believed & wrote that #endo was more common in his private clinic patients that those in the regular hospital wards
“The Scourge of the private patient”
BTW Ward patient carried (still carries) racial and socioeconomic connotations
Meigs believed & wrote that #endo was more common in his private clinic patients that those in the regular hospital wards
“The Scourge of the private patient”BTW
Ward patient carried (still carries) racial and socioeconomic connotations
6/
Implicit in Meigs’ false belief was the racist assumption that women of color were less “civilized” than their “white” counterparts and thus less susceptible to stress of modern life
Back then: Stress Endo
Implicit in Meigs’ false belief was the racist assumption that women of color were less “civilized” than their “white” counterparts and thus less susceptible to stress of modern life
Back then: Stress
Endo
7/
This was also happening in cancer during same time period…
“African-americans rarely develop cancer due to their slow-paced agrarian lifestyles”
This was also happening in cancer during same time period…
“African-americans rarely develop cancer due to their slow-paced agrarian lifestyles”
8/
Was not until 1976 that African American gynecologist Dr. Donald Chatman published a critique of this racial bias and its neg impact on patient care;
1 in 5 of his private black patients had LSC evidence of endo, but 40% had been incorrectly diagnosed with PID
Was not until 1976 that African American gynecologist Dr. Donald Chatman published a critique of this racial bias and its neg impact on patient care;
1 in 5 of his private black patients had LSC evidence of endo, but 40% had been incorrectly diagnosed with PID
9/
Why?
Pervasive myth that women of color are “immune to endo” and that they were “more promiscuous than their white peers”
Old school pelvic pain differential:
White = endo
Black = PID
Again,
Why?
Pervasive myth that women of color are “immune to endo” and that they were “more promiscuous than their white peers”
Old school pelvic pain differential:
White = endo Black = PIDAgain,
10/
Flash forward to the 2000’s, and we are still dealing with paucity of literature on topic of race and endometriosis
Why? Selection bias. Homogenous studies. Access to health care, Variations in socio-cultural acceptance of surgical intervention/diagnosis
etc. etc. etc
Flash forward to the 2000’s, and we are still dealing with paucity of literature on topic of race and endometriosis
Why? Selection bias. Homogenous studies. Access to health care, Variations in socio-cultural acceptance of surgical intervention/diagnosis
etc. etc. etc
11/
Minimal research exists on presentations of endometriosis in various ethinic groups
Not all pts perceive, report, experience pain symptoms in the same way
Ethincity & socioeconomic status influences access to care, specialist referral, diagnosis & treatment offered
Minimal research exists on presentations of endometriosis in various ethinic groups
Not all pts perceive, report, experience pain symptoms in the same way Ethincity & socioeconomic status influences access to care, specialist referral, diagnosis & treatment offered
12/
The take away:
Endo can occur in ALL women
Pts of various ethnicity may have diff. presenting symptoms & express diff. treatment preferences
Research needs to focus on pt symptomatology & disease experience using validated & cultural sensitive pt outcomes measures
The take away:
Endo can occur in ALL women Pts of various ethnicity may have diff. presenting symptoms & express diff. treatment preferences Research needs to focus on pt symptomatology & disease experience using validated & cultural sensitive pt outcomes measures
13/13
If up to the challenge to contribute meaningfully to endo research...
Involve patients, communities, patience advocacy groups -> don’t go it alone.
Fin.
#endometriosis
Awesome article, @DrSonySinghMD
If up to the challenge to contribute meaningfully to endo research...
Involve patients, communities, patience advocacy groups -> don’t go it alone.
Fin.
#endometriosis
Awesome article, @DrSonySinghMD
