When a study about the timing of female puberty by the Pediatric Research in Office Settings (PROS) network was published in Pediatrics in 1997, it was considered by many to be a practice-changing article. This study reported that Black girls normally experience thelarche (breast development) at earlier ages than White girls, and this resulted in widespread changes in how precocious puberty is defined.
This week, Pediatrics is early releasing an article by Adeiyewunmi Osinubi and colleagues at Brown University, entitled, “Are Black Girls Exhibiting Puberty Earlier? Examining Implications of Race-Based Guidelines,” which asks us to once again reconsider how we approach girls who experience thelarche at an early age (10.1542/peds.2021-055595).
The authors point out that, when we use race as the explanation for a phenomenon, we do the patient an injustice. We are perpetuating race pathologization, which is defined by the authors as the “practice of attributing poor health outcomes to an individual race rather than to the sociopolitical factors that influence these outcomes.”
In the case of early pubertal development, our differential diagnosis for the young patient with early breast development should always include pathologic causes, such as central nervous system tumors, regardless of the patient’s race.
We also need to consider the potential that systemic racism may contribute to earlier thelarche. The authors mention a few of the ways that this could happen:
- Obesity, which is more prevalent when there is food insecurity and fewer financial resources
- Environmental hazards, including endocrine disrupting chemicals (such as bisphenol A, which is found in plastic bottles, or estrogens that may be in personal care products)
- Early stress
The article discusses later implications of early puberty for these girls and offers suggestions for how we can counsel families more effectively.
Take a look at this article. For me, this is one of those articles that changes the way that I practice, and I suspect and hope that it will have a similar impact on your practice.