In last week’s episode of The Genetics Podcast, Patrick sat down with Dr. Versha Pleasant, Clinical Assistant Professor at the University of Michigan and Director of the Cancer Genetics and Breast Health Clinic at the Von Voigtlander Women’s Hospital. Versha’s work focuses on addressing racial health disparities, particularly in breast cancer outcomes for Black women, and expanding access to genetic testing and counseling.
Tackling racial disparities in breast cancer
Versha shed light on the staggering racial disparities in breast cancer outcomes. Black women have a 40% higher mortality rate from breast cancer than white women and are 70% more likely to experience delays in treatment—factors that contribute to poorer outcomes. She described these inequities as a “gymnasium of light switches,” where multiple factors, such as more aggressive cancer subtypes, delays in care, and social determinants of health, collectively worsen outcomes.
To address these challenges, Versha advocated for a three-pronged approach:
1. Patient-level initiatives: Increasing community education and awareness about breast cancer prevalence and its disproportionate impact on Black women.
2. Health systems-level solutions: Expanding access to mammography, genetic testing, and insurance coverage to reduce barriers to care.
3. Policy-level change: Developing systemic policies that prioritize equitable healthcare access and preventive measures.
She also spoke about how genetic testing and counseling play a key role in early detection and prevention, offering opportunities to save lives and reduce disparities.
The case for universal genetic testing
Versha discussed her recent paper advocating for universal genetic counseling and testing for Black women, particularly in the context of breast cancer. Her argument is based on data showing Black women are more likely to meet the National Comprehensive Cancer Network (NCCN) criteria for genetic testing due to higher rates of triple-negative breast cancer and early-onset breast cancer.
While acknowledging challenges like cost, medical mistrust, and access, she proposed solutions like community education, hiring more genetic counselors from underrepresented backgrounds, and making use of genetic testing as a policy-level intervention to reduce disparities.
Solutions for community engagement
One of Versha’s ongoing projects is the Genetic Risk Assessment with Mobile Mammography Study, which integrates genetic counseling into routine breast cancer screening. By offering risk assessments at the time of mammography, the study has already identified that nearly half of participants meet criteria for genetic counseling, which shows the missed opportunities in standard care.
The project combines risk assessment with community engagement, hosting events at churches, sororities, and health fairs to educate and build trust. Versha shared that she hopes to scale the program nationally, envisioning a future where genetic counseling and testing are seamlessly integrated into preventive care.
Breaking down barriers in research and education
Versha also introduced the concept of racial health duplicity, which describes the dual harm of Black communities being overrepresented in harmful studies while being underrepresented in beneficial research, such as genome-wide association studies (GWAS). She highlighted the historical mistrust stemming from unethical medical practices, such as the Tuskegee Syphilis Study and the exploitation of Henrietta Lacks, and called for greater representation and inclusion in genetic research.
Advice for aspiring physicians and advocates
For those considering a career in medicine or advocacy, Versha shared three key pieces of advice:
1. Be gritty: Build passion and perseverance to overcome challenges.
2. Connect your interests with your work: Find areas where your talents align with serving others.
3. Practice compassion daily: Make empathy a habit, both in and out of the clinic.
Looking ahead
Versha is optimistic about the future of genetic medicine, particularly in integrating it into preventive care and addressing racial health disparities. She called on healthcare providers, researchers, and policymakers to act boldly because Black women are dying unnecessarily from a very common disease, noting that it's time for the medical community to step up.
Listen now:
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