Underrepresentation of Racial Minorities in Breast Surgery Literature

Abstract

Objective: In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. Background: The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. Methods: Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into “White” or “non-White.” Data were evaluated with pair-wise and linear regression statistics. Results: Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. Conclusions: There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.

Asian American Pacific Islander Representation in Outcomes Research: NSQIP Scoping Review

“…8 Researchers are addressing systemic racism and implicit bias through scholarship. [9][10][11][12][13][14][15][16] This dedication has resulted in a dramatic increase in research published on health disparities in surgery in the last decade, from 235 PubMed indexed studies in 2008 to 1,061 studies published in 2018. 17 Anecdotally, it has been noted that the vast majority of these studies on racial and ethnic disparities have focused on outcomes of White, Black, and Hispanic populations.…”

Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey

“…A similar underrepresentation of darker skin tone was reported in training textbooks in Canada and US, respectively (2, 3). Furthermore, in two studies assessing images in plastic surgery, only 20% of images represented darker skin tones (6,7). Recently, another study showed that darker skin phenotypes are underrepresented in the UWorld Step 2 QBank, a popular study tool for medical students seeking US residencies (15).…”

“…An example is demonstrated by skin color. Studies assessing diversity of skin representation among textbooks in the United States (US), Canada (2,3) and in major scientific journals (4)(5)(6)(7) have shown that the majority of images used within these educational materials are of light skin tones (defined in the oxford English dictionary as the color of the surface of someone's skin). Furthermore, descriptors of dermatological features also lack diversity; many descriptions of rashes focus on redness, pallor, purpura and cyanosis all of which are more difficult to recognize in darker skin tones or may not be present at all.…”

An Evaluation of Racial Diversity in Craniofacial Surgery Literature

“…Previous work by our group found racial differences in images published across plastic surgery topics and medical literature. 15,18 For this study, we focused on craniofacial literature for multiple reasons. The face is an integral part of an individual's identity and differences in facial features can be suggestive of different races and ethnicities.…”