MCAT Critical Analysis and Reasoning Skills Practice Test 14

Hispanics are the fastest growing minority in the United States. "Hispanics," "Latinos," "Chicanos," "Mexican Americans," "Puerto Ricans," "Cuban Americans," and so on, are all designations used to describe this large, heterogeneous population with different cultural, ethnic, geographic, and social backgrounds. There is still no clear definition of the term "Hispanic." The data available regarding the incidence, morbidity, and mortality from cancer in "Hispanics" are scarce, scattered, outdated, and often incomplete.

From the studies looking at the accessibility and availability of medical care to this population, few have examined in detail the variability within the entire Hispanic population. The aggregation of culturally distinct subgroups, which have resided in the United States for different periods of time, into a more inclusive "Hispanic" category assumes that all persons of Mexican, Central and South American, Cuban, and Puerto Rican extraction have similar perceptions, true or not, of cancer risks and share needs and experience similar barriers in using health services. There is, however, no clear evidence for this assumption.

On the contrary, there is evidence that each group has specific characteristics that make them different and independent from one another, despite the fact that they also share some commonalities. Recruitment of minorities, specifically Hispanics, to clinical trials has been a significant problem that can potentially be overcome by adequate protocol development and investigator education regarding specific knowledge, attitudes, and needs of minority populations. It is timely and refreshing to see a recent anthropological evaluation of the problem of cancer in (female) Hispanics. It reviews the knowledge, attitudes, and barriers (KAB) for breast and cervical cancer in four different groups of women of Hispanic/Latino origin and compare them among themselves and against a group of physicians' KAB.

Unfortunately, there are no complete data regarding cancer in all Hispanic groups. We currently do not know the true number of cancer cases in Hispanics, nor do we have accurate morbidity, mortality, and survival data from these groups. As a result, we are not really able to fully understand or appreciate the physical, emotional, and financial impact of cancer in Hispanic patients and their families. Mortality from cancer in Hispanics is difficult to assess because of the limited data that are available. Utilizing existing community groups and organizations and helping to create strong community bonds could improve the potential for success of minority cancer control efforts and patient recruitment to clinical trials. These programs can become networks of information with inherent trust from their respective communities. In developing these interventions, we should increase our awareness of the needs of all different Hispanic groups and assure that programs are developed together with these communities, in order to assure that they are culture- and community-sensitive, respecting and complementing the Hispanic heritage.

[The recent anthropological study reminds] us that perhaps there are no true knowledge deficits, but rather misconceptions regarding the true cancer risks. Thus, it emphasizes two facts: (1) we must get to know and understand the population(s) with whom we plan to work; and (2) there is a strong need for education, not only of the communities with whom we work but, perhaps more important, of the scientific teams (physicians, nurses, anthropologists, social workers, etc.) that will work in and with those communities. Preliminary data from our group have shown that community-based lay health educators ("Promotoras de Salud"), working together with local health departments can be successful in reaching, educating, and increasing recruitment of Hispanic (Mexican-American) women to cervical cancer screening programs and to cancer clinical trials. This program is now being piloted through the Southwest Oncology Group in San Antonio's (Texas) Hispanic community. The time has come to revise and update our sources of information and data gathering. Careful study of each Hispanic subgroup is essential in order to have a realistic picture of the overall cancer problem in the United States today. These studies must include a clearer definition of the differences among the many Hispanic subgroups with their respective problems and barriers to cancer care.

Material used in this particular passage has been adapted from the following source:

M. R. Modiano, "Breast and Cervical Cancer in Hispanic Women," Medical Anthropology Quarterly, ©1995.

1. The primary purpose of the passage is to:

• A. prompt others to create a better, more accurate definition of "Hispanics."
• B. promote a better understanding of Hispanic populations in order to recognize and serve their cancer health needs.
• C. advocate for the term Hispanic to be discarded for its ineffectively inclusive description of diverse peoples.
• D. educate Latino cancer patients about available resources.

2. The author characterizes Hispanics as which of the following?

• A. A large, diverse minority of Spanish speaking people in the United States with unusually strong community bonds
• B. A population whose various members face similar obstacles in the health care system
• C. A group whose known epidemiological cancer data may be lacking
• D. A heterogeneous people who are represented well in clinical trials

3. Which of the following are limitations that exist currently, as stated by the passage?

I. The view of Hispanics as a culturally monolithic people

II. Language barriers between health care professionals and patients

III. Interference by medically untrained community groups

• A. I only
• B. I and II only
• C. I and III only
• D. II and III only

4. It can be inferred that the author would be in favor of a program with all of the following aspects EXCEPT:

• A. a careful study of each Hispanic subgroup focusing on commonalities between them.
• B. a community based initiative that is congruent with Hispanic cultures.
• C. an emphasis on cancer screening in women.
• D. education of medical professionals about the populations they serve.

5. The author deems all of the following as positive aspects of the recent study discussed EXCEPT:

• A. pointing out potentially helpful ways in which clinical trial recruitment can be improved.
• B. separating Hispanic women in the study into specific groups.
• C. utilizing an anthropological approach in analyzing cancer data in Hispanics.
• D. gathering data on all of the different Hispanic subgroups.

6. The tone of the passage can best be described as:

• A. derisive and accusatory.
• B. distressed but indifferent.
• C. optimistic and analytical.
• D. clinical and regretful.

7. The intended audience of this passage is most likely:

• A. cancer hospitals or research center administrators.
• B. the American public at large.
• C. Hispanic women with breast or cervical cancer.
• D. the Southwest Oncology Group.