SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York.
Maimonides Medical Center, Division of Breast Surgery, Brooklyn, New York.
J Surg Res. 2023 Nov;291:677-682. doi: 10.1016/j.jss.2023.07.019. Epub 2023 Aug 8.
The lack of racial diversity depicted in medical education texts may contribute to an implicit racial bias among clinicians. This bias influences outcomes, as familiarity with the various cutaneous manifestations of disease is essential to making an accurate diagnosis. To better understand the racial disparities in breast surgery, we sought to determine the extent of skin tone representation depicted in images of breast surgery and pathology textbooks.
Textbooks were screened for color images of conditions with sufficient skin tissue present to assign the Fitzpatrick skin phototype (FSP). Figures were independently assigned an FP score (range: 1-6), and subdivided into "light skin" (FP 1-3) and "dark skin" (FP 4-6). Number of figures in each category and percentage of patients with each skin tone were calculated.
557 figures were included. Among 12 textbooks reviewed, seven textbooks were from the discipline of surgery, while five were pathology-related. Textbook year of publication spanned from 1996 to 2018. Overall, 533 (95.7%) figures depicted patients with light skin color versus 24 (4.3%) with dark skin color. There was no association between FP score and year of textbook publication (P = 0.69).
Patient images in breast textbooks are overwhelmingly of light skin tones, excluding patients with darker skin tones. The dearth of images depicting dark skinned individuals did not improve over time. Inclusion of patients of color in future textbooks may help reduce racial disparities within breast cancer care.
医学教材中缺乏种族多样性的描绘可能会导致临床医生中存在隐性种族偏见。这种偏见会影响治疗结果，因为熟悉疾病的各种皮肤表现对于做出准确的诊断至关重要。为了更好地了解乳房手术中的种族差异，我们试图确定乳房手术和病理学教材中所描绘的肤色代表性程度。
筛选了有足够皮肤组织的条件的彩色图像的教材，以确定 Fitzpatrick 皮肤光型（FSP）。这些图像由独立的人分配 FP 评分（范围：1-6），并细分为“浅色皮肤”（FP1-3）和“深色皮肤”（FP4-6）。计算了每个类别的图像数量和每个肤色的患者比例。
共纳入 557 个图像。在审查的 12 本教材中，有 7 本来自外科领域，5 本与病理学相关。教材出版年份从 1996 年到 2018 年不等。总体而言，533 个（95.7%）图像描绘了浅色皮肤的患者，而 24 个（4.3%）描绘了深色皮肤的患者。FP 评分与教材出版年份之间没有关联（P=0.69）。
乳房教材中的患者图像绝大多数是浅色皮肤，排除了深色皮肤的患者。描绘深色皮肤个体的图像数量并没有随着时间的推移而增加。在未来的教材中纳入有色人种患者可能有助于减少乳腺癌护理中的种族差异。
