Guest: Ray Greenberg, M.D., Ph.D., MUSC President
Host: Linda Austin, M.D. – Psychiatrist
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing today Dr. Ray Greenberg, who is the President of the Medical University of South Carolina. Dr. Greenberg, I know you have very deep and longstanding interest in disparities of care and that’s such an important topic here in South Carolina. Let’s think a little bit about cancer. How does that issue play out here in South Carolina with regard to cancer?
Dr. Ray Greenberg: Well, Dr. Austin first of all, it’s a great privilege to be with you today and I thank you for including me in your interviews. I do want to say that my own personal research has been very involved in the issue of particularly racial differences and risk of developing cancer and then the prognosis from cancer after people are diagnosed and particularly looking at African-Americans versus Caucasians in United States and that’s a research that was involved in before I came to South Carolina, but South?Carolina really could the poster child for many of these, the same disparities. We see much higher risks of certain kinds of cancer in the African-American population; examples would be cervical cancer in women and prostate cancer in men, but we also see cancers that aren’t more frequent in African-Americans, but if they are diagnosed, they have worse prognoses than Caucasians and an example of that would be breast cancer where the disease is a little bit more frequent in white women, but if you get it, you tend to get it at a more advanced stage in more aggressive form of the disease if you are an African-American.
Dr. Linda Austin: So to what degree do the disparities have to do with anything genetic versus when these diseases are diagnosed and how they are treated?
Dr. Ray Greenberg: That’s a great question and it’s when that a lot of work is being directed towards today. The truth of the matter is we know very little about the underlying genetic differences related to race. We do know certain genes that increase the risk that someone will get cancer, but we don’t know yet that we can’t explain that African-Americans get certain cancers more frequently because of specific genetic defects, but I think there is growing evidence that there is likely to be some biological differences in the disease. If you look at breast cancer in African-American women for example as opposed to the Caucasian women, what you see is more tumors that have a more aggressive character to them. There are different cell types and they tend to be more abnormal in certain ways than in the tumors that occur in white women; that probably relates to either risk factors, differences in the population, or genetic differences, and reasons that people are getting those cancers and partly it probably relates to the fact when we talk about breast cancer, it’s really multiple different diseases and we just have a broad category name over it and so the spectrum of the variants that African-American women get as opposed to white women may be different. This is also very much true in uterine cancer in African-American women versus Caucasian women. In African-American women, they have much more aggressive tumors whereas white women tend to have more endometrial tumors, may well be medication related. There have been lots of studies looking at estrogen use in endometrial cancer, so that’s the lining of the uterus whereas when African-American women get uterine cancer, they tend to get tumors of the muscle wall, sarcomas and they are much more aggressive tumors.
Dr. Linda Austin: What more could we be doing to diminish some of these disparities?
Dr. Ray Greenberg: Well, I think, one thing that we haven’t talked about at all is really Access To Care. How quickly do people get into the diagnostic system to be recognized as having cancer? Why that’s important is because the earlier your cancer is recognized, the more aggressive we can be in treating it and hopefully eradicating it. Once the cancer has gotten larger and spread, it’s much harder to treat and cure someone from the disease. So, getting someone in very early is absolutely keyed as we all know there are differences in Access To Care that are related to economic status and insurance status and whole host effector, so I think one of the important things from a system point of view that we need to deal with is educate the public about early warning signs of cancer and also make sure that there is good access to screening methodologies and the Hollings Cancer Center has been very aggressive through its mobile van to go out to communities where there isn’t mammography, for example, accessible to women and really make that technology available, really state-of the-art mammography. This is not just routine mammography, this is digital mammography now that’s being brought into communities where there historically has not been a good access to care, so I think that’s one important thing that we can do.
Dr. Linda Austin: Dr. Ray Greenberg, thank you so much for talking with us today.
Dr. Ray Greenberg: That’s my pleasure.
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