Talking Health Disparities with Dr. Cheryl T. Lee

In celebration of Black History Month, BCAN sat down with Dr. Cheryl Lee to get her thoughts about disparities in both the patient and healthcare provider communities.

Dr. Cheryl T. Lee is a urologist at The Ohio State University Wexner Medical Center, which is home to the James Cancer Hospital and the OSU Comprehensive Cancer Center. She proudly holds the Dorothy M. Davis Chair in Cancer Research and is the former Chief Health Equity Officer at Wexner Medical Center. She also served on BCAN’s Board of Directors as well as its Scientific Advisory Board.

Dr. Cheryl Lee, Ambassador for the Columbus, Ohio Walk to End Bladder Cancer
Dr. Lee

Health disparities

BCAN recently spoke with Dr. Lee about her views about inequities in the medical field, beginning with health disparities.  She explained that health disparities are differences in health outcomes, often experienced between individuals of differing races, genders, and socioeconomic status. She said, “Health inequities limit one’s ability to really fulfill their health potential often due to social determinants of health.  These inequities regularly result in health disparities.” 

As a urologist, Dr. Lee has seen social determinants in action resulting in health disparities. For example – many studies have shown that, in aggregate, African American/Black patients have lower survival rates and present at later stages of a disease like bladder cancer when compared to White patients. They often have less access to specialty care and are not offered a full range of opportunities to treat their disease.  She also noted that people of color may not be encouraged to join clinical trials and/or may not feel comfortable participating in them, particularly in cancer therapy.  As another example, low income patients have less access to cancer screening and effective treatments. This reduced access has been shown to extend to academic medical centers and comprehensive cancer centers.

Dr. Lee speaking at a Columbus Walk to End Bladder Cancer

Bladder cancer health disparities can also manifest themselves in the sex of the person with the disease.  Dr. Lee noted that women with bladder cancer have a delayed presentation and prolonged time to diagnosis which can contribute to worse outcomes.

Different factors in health disparities

The results that patients see from treatments can also be impacted by where they live.  Dr. Lee noted, “Rural communities tend to have less access to high volume medical centers and the range of treatment options that those facilities offer.”  She also stated that health behaviors of bladder cancer patients can differ from those in different areas because of exposure to chemicals or increased rates of smoking.    

Impediments for aspiring urologists

Social determinants do not only impact patients; they can impact aspiring doctors too.  Dr. Lee noted that impediments exist for people of color who are considering a career in medicine.  She added, “Access to role models, mentors, and opportunities for scientific research are critical. Training to become a physician is lengthy. The journey demands substantial social and personal support, determination, commitment, and resources to attend college, medical school and intervening ‘gap’ years to gain additional knowledge and skills often in research laboratories or other medical settings.”  She added, “Financial insecurity may demand that students work while training.  This can limit opportunities to shadow other physicians or be part of summer research programs are often unpaid experiences. Students who must forego these opportunities because of work obligations miss chances to build their portfolios and make important professional connections, particularly in a competitive field like urology. In fact, Dr. Lee noted that people of color are underrepresented in urology. She said, “Urology has traditionally been a homogenous field with roughly 11% women, 2.5 % percent African Americans, and 4.5% Hispanic physicians practicing in this US specialty.” She also noted that the number of women urologists and people of color in the field is “disproportionate to patient demographics that we see.”  

When asked if she had ever been in a situation in which she was the only person who looked like her in the room, Dr. Lee answered “That situation defined most of my professional experiences in the early and mid-part of my career. There haven’t been a lot of people who look like me in urology, although our trainees are much more diverse than they used to be. I expect the next generation will train and grow in a more inclusive environment. Ultimately my goal has been to focus on the goals and ambitions of my patients and my trainees to improve the field and pave the way for others.”

The future is bright

Dr. Lee noted that urology is a very competitive field to get in to and that some institutions are looking at novel ways to identify applicant traits that will predict their success as a talented surgeon, compassionate physician, dedicated educator, and a lifelong learner and innovator with an aim of advancing urology.  She said, “We are moving beyond standardized test scores and honorific societies to actually find the leaders of tomorrow. Our future is certainly bright.”