Developing Curriculum to Help Biomedical Engineers Connect Systemic Racism to Cancer Health Disparities

Introduction:: As a biomedical engineering graduate student in the summer of 2020, after the murders of Breonna Taylor, Ahmaud Arbery, and George Floyd, I wanted to find a way to connect my work as a cancer researcher with the need to work towards a more just, equitable, diverse, and inclusive society. After eight years of higher education, this was the first point I was exposed to the issue of cancer racial health disparities. Cancer remains one of the leading causes of death in the US affecting all population groups, and yet certain groups bear a disproportionate burden for cancer incidence and mortality^1,2. To my knowledge, this topic had not been discussed in any of my courses as a biomedical engineer during my undergraduate or graduate careers. I mentioned to a friend that I wanted to one day teach a cancer biology course for engineers that specifically applied a lens of racial equity to explore how the history of racial discrimination in America has led to health inequities and think about solutions for closing the healthcare gap. She replied, “What’s stopping you from teaching that class right now?”


Materials and Methods:: I developed a curriculum for a three-workshop series for biomedical engineering undergraduate students, graduate students, staff, and faculty to connect how issues of systemic racism in America are related to cancer health disparities. Each interactive workshop covers a variety of topics ranging from disparities in cancer biology and cancer research, to cancer epidemiology and environmental racism, to disparities in cancer prevention, diagnosis, and treatment. The curriculum design incorporates elements of active learning, including polling, think-pair-share, breakout group discussions, case study interpretation, and asynchronous content engagement. All participants were invited to join a message board for extended learning and discussion outside of the workshop. I have taught the workshops in both a virtual (Figure 1) and in-person context and the material has even been adapted for discussions with high school students. I have taught these workshops at 4 universities (Georgia Tech, Vanderbilt University, University of Minnesota, and University of Mississippi) to approximately 250 participants, including high school students, undergraduate students, graduate students, faculty, and staff members. By incorporating the feedback from prior participants, I am adjusting and expanding the content of this workshop series into a full course to integrate into a BME department’s curriculum.


Results, Conclusions, and Discussions:: The first workshop is designed to help participants discuss racial health disparities through the lens of cancer biology and cancer research. Participants were first exposed to the basics of cancer biology and then introduced to the topic of racial health disparities, social determinants of health, and the effect of systemic racism on health. We discussed the use and misuse of genetics in medicine and explored the difference between race-based and race-conscious medicine³. In the last section of the workshop, we shifted our attention to common cancer research techniques, the lack of adequate representation of people of color in genetic research tools and oncology clinical trials, and historical reasons why minority population groups are underrepresented in research tools^4,5. The second workshop shifted focus to the environmental risks of cancer and the effect of housing segregation on stress, access to healthcare, and diet. Participants took part in a breakout discussion examining case studies of environmental racism, such as the issue of heavy metal mining on tribal land leading to increased kidney disease and chronic illness in Indigenous communities⁶. This workshop also discussed the study of cancer epidemiology and helped participants explore the topic of social determinants of health in epidemiological data. The final workshop covered racial health disparities in cancer prevention, diagnostics, and treatment. Beyond discussing medical misconceptions and mistrust which leads to lower screening and surgery rates in communities of color, we also covered how targeted programs for increasing screening and providing customized support to navigate the treatment process to communities of color helps to reduce health disparities^7,8. Each workshop is designed to end with a time of reflection where participants discuss what actions should be taken next at multiple levels of society, from individual action to the responsibility of the scientific and research communities.

Health equity is an important lens for all scientists and researchers to employ when approaching their work and, as long as inequities still exist, we need to do what we can to educate others about them and encourage people to come up with creative solutions to creating more equitable healthcare for all people.


Acknowledgements (Optional): :

References (Optional): : 1. Lawrence, W.R., McGee-Avila, J.K., Vo, J.B., Luo, Q., Chen, Y., Inoue-Choi, M., Berrington de González, A., Freedman, N.D., and Shiels, M.S. (2022). Trends in Cancer Mortality Among Black Individuals in the US From 1999 to 2019. JAMA Oncology 8, 1184–1189. 10.1001/jamaoncol.2022.1472.

2. Zavala, V.A., Bracci, P.M., Carethers, J.M., Carvajal-Carmona, L., Coggins, N.B., Cruz-Correa, M.R., Davis, M., de Smith, A.J., Dutil, J., Figueiredo, J.C., et al. (2021). Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 124, 315–332. 10.1038/s41416-020-01038-6.

3. Cerdeña, J.P., Plaisime, M.V., and Tsai, J. (2020). From race-based to race-conscious medicine: how anti-racist uprisings call us to act. The Lancet 396, 1125–1128. 10.1016/S0140-6736(20)32076-6.

4. Popejoy, A.B., and Fullerton, S.M. (2016). Genomics is failing on diversity. Nature 538, 161–164. 10.1038/538161a.

5. Duma, N., Vera Aguilera, J., Paludo, J., Haddox, C.L., Gonzalez Velez, M., Wang, Y., Leventakos, K., Hubbard, J.M., Mansfield, A.S., Go, R.S., et al. (2018). Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. JOP 14, e1–e10. 10.1200/JOP.2017.025288.

6. Lewis, J., Hoover, J., and MacKenzie, D. (2017). Mining and Environmental Health Disparities in Native American Communities. Curr Environ Health Rep 4, 130–141. 10.1007/s40572-017-0140-5.

7. Grubbs, S.S., Polite, B.N., Carney, J., Bowser, W., Rogers, J., Katurakes, N., Hess, P., and Paskett, E.D. (2013). Eliminating Racial Disparities in Colorectal Cancer in the Real World: It Took a Village. J Clin Oncol 31, 1928–1930. 10.1200/JCO.2012.47.8412.

8. Cykert, S., Eng, E., Walker, P., Manning, M.A., Robertson, L.B., Arya, R., Jones, N.S., and Heron, D.E. (2019). A system‐based intervention to reduce Black‐White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers. Cancer Med 8, 1095–1102. 10.1002/cam4.2005.