Students studying outside the library

Van Hale researches disparities in cancer diagnoses

COS Charlotte Van Hale 382x255

Community of Scholars project compares Caucasians, African-Americans, Hispanics 

SPARTANBURG, S.C. - In the summer of 2009, Wofford College biology major Charlotte Van Hale conducted a retrospective study of patients with gastrointestinal tumors over the past 10 years at Greenville Hospital. Then during Wofford’s January 2010 Interim, she visited Guatemala, where she developed a strong interest in Hispanic people.

Van Hale wanted to build on both of those experiences and that’s how she developed her Community of Scholars research project for summer 2010: “A Comparative Study of the Stage of Breast Cancer at Diagnosis among White, Black and Hispanic Women.” She was one of 19 student fellows participating in the interdisciplinary program this summer.

She sees her topic as a very important one, pointing to research that shows that African-American and Hispanic patients receive diagnoses of breast cancer at later stages than do Caucasian patients, and in many cases have worse outcomes. She examined the biological, social and cultural factors that play into the reasons for that, with a plan for being able to understand how to better educate and treat those Hispanic breast cancer patients.

“With the major overhaul in health care going on right now, I knew that insurance status would be an interesting aspect to examine as a possible reason,” she says. “You also have social differences.” She notes that one Hispanic contact who works in the Greenville Hospital System shared that Hispanics in this area often don’t have primary care physicians because the population tends to be transient, and fear of deportation also may impact some, she says, and “affordability is definitely a factor as well.”

Van Hale tackled a lot of research in a short period of time for her project, looking at the South Carolina database on patients who have been treated for breast cancer over the past five years. She likened that to comparing apples to apples, “keeping the patients’ ages constant, finding Hispanic, white and black patients of the same age.” She then compared insurance status, pathology, stage, type of treatment options taken – a wide array of factors – to see what was different and what was causing the disparities.

“Multiple studies have confirmed that, on average, black and Hispanic patients receive their breast cancer diagnosis at later stages than Caucasian patients, and, therefore, have worse outcomes,” Van Hale says in her final report. According to her data obtained from the cancer database at Greenville Hospital Systems and from the South Carolina Tumor Registry, Caucasians are 1.3 times more likely to be diagnosed with early (stage 1) breast cancer than are Hispanics, and 1.6 times more likely than African-Americans.

In contrast, she says, both Hispanics and African-Americans in South Carolina are 1.3 times more likely to be diagnosed with late-stage (stage 4) breast cancer than Caucasians in the state. In looking for the cause and impact of the disparities, she compared outcome, tumor size, nodal status, tumor type, insurance status, and type of treatment between Caucasian, African-American and Hispanic women receiving diagnosis and care in South Carolina.

“By comparing these biological and social factors in breast cancer patients of different ethnicities, I discovered some of the causes responsible for late diagnosis and poor outcome in these minority groups. This information can assist in narrowing these gaps by understanding how to better communicate with, educate and treat breast cancer patients as well as their health care providers.”

Van Hale notes that while she is not a Spanish major, like most Wofford students she is interested in a wide variety of topics and feels fortunate to be at a liberal arts college where she can conduct a research project of her own design that allows her to pursue those multiple interests as part of the Community of Scholars.

- Brett Borden