Cancer health disparities remain a challenge in the United States, despite some strides being made to reduce these disparities, according to a new report from the American Association for Cancer Research (AACR) that was released in a virtual presentation on September 16, 2020. Furthermore, many of the populations affected by cancer care disparities are the ones affected by disparities related to the COVID-19 pandemic, AACR experts said.
The goal of the “AACR Cancer Disparities Progress Report 2020: Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations” (https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2020/09/AACR_CDPR_2020.pdf) is to raise awareness of the immense toll that cancer exacts on racial and ethnic minorities in the United States.
Advances in cancer detection and treatment have not benefited all Americans equally, said AACR President Antoni Ribas, MD, PhD, FAACR, Professor of Medicine, University of California, Los Angeles.
“Progress has come too slowly for people of color, and the monumental cost of cancer health disparities in terms of health care inequalities, premature death, and the impact on communities must be immediately addressed,” said Dr Ribas. “An individual’s race, ethnicity, geographic location, or income should not dictate his or her cancer outcomes, but unfortunately, this is exactly what is happening today,” he added.
Disparities in Cancer Rates
According to the report, mortality from several types of cancer is disproportionately higher in minority groups. African Americans have had the highest overall cancer death rate of any racial or ethnic group in the United States for more than 4 decades.
African-American men and women have a 111% and 39% higher risk for dying from prostate cancer and breast cancer, respectively, compared with their white counterparts.
Asian/Pacific Islander adults are twice as likely to die from stomach cancer as white adults, and American-Indian/Alaska-Native adults are twice as likely to have liver and bile duct cancer compared with white adults.
Differences in education and income affecting access to care are also significant factors contributing to cancer health disparities. For example, men living in the poorest counties in the United States have a 35% higher colorectal cancer (CRC) death rate than men living in the most affluent counties. Similarly, women of low socioeconomic status with early-stage ovarian cancer are 50% less likely to receive current standard of care than women of high socioeconomic status, Dr Ribas noted.
Racial and ethnic minorities and other underserved populations are also less likely to receive the standard of care recommended for their type and stage of cancer.
“Several recent studies have shown that racial and ethnic disparities in outcomes for several types of cancer, including prostate cancer and multiple myeloma, can be eliminated if all patients have equal access to standard treatment,” according to the report.
The disparities in cancer health have had an adverse economic impact on the nation as well.
“Studies have shown that eliminating health disparities for racial and ethnic minorities from 2003 to 2006 would have reduced health care costs in the US by $1 trillion, thus the impact of not addressing these disparities is far reaching, and will not only affect us now but will also significantly impact generations to come,” said John D. Carpten, PhD, Chair of the AACR report’s steering committee, and Director, Institute of Translational Genomics, University of Southern California, Los Angeles.
Gaps in Cancer Screening
The disparity in cancer screening was highlighted by Marcia R. Cruz-Correa, MD, PhD, member of the report’s steering committee, and Executive Director, University of Puerto Rico Comprehensive Cancer Center, San Juan.
It is estimated that 42% of the incidence rate disparity and 19% of the death rate disparity in CRC between African Americans and whites were attributable to differences in CRC screening rates, according to the report.
Hispanics have the lowest CRC screening rate of any racial or ethnic group in the United States, said Dr Cruz-Correa, whereas American Indians/Alaska Natives have the lowest breast cancer screening rate of any racial/ethnic group in the United States.
“Multiple barriers to screening have been identified, including lack of access to health care, poor knowledge of cancer risk, mistrust of the health care system, and specifically for Hispanics, having English as a second language. These have been shown to be important drivers in the disparity in cancer screening,” she said.
Equity Needed in Clinical Trials
A substantial portion of the briefing was devoted to underrepresentation of racial and ethnic minorities in cancer research and clinical trials.
“Black and Latino patients with breast, lung, colorectal, and prostate cancer are almost 30% less likely than white patients to enroll in clinical trials testing treatments for these four types of cancer,” said Rep William B. Hurd (Texas).
“In this particular area, strong efforts are currently under way to increase the number of individuals from diverse populations to participate in clinical research,” said Dr Ribas. “For example, the FDA recently issued draft guidance for the pharmaceutical industry with recommendations to diversify clinical trial populations. The guidance is intended to improve the collection of clinical data that are more valid to the real-world population of people with cancer.” In addition, the AACR is establishing a task force that will focus on racial inequalities in cancer research.
The report highlighted 5 proposals to enhance clinical trial participation of minorities, including:
- Enhance recruitment of racial and ethnic minorities for clinical trials in cancer based on disease incidence rather than their proportion in the general population
- Increase clinical trial availability by including community-based oncology practices
- Simplify and expand eligibility criteria
- Integrate patient navigators, community health workers, and patient advocates in the design, recruitment, and implementation of clinical trials
- Expand federal policies that require private insurance companies to cover routine medical costs of participating in clinical trials.
Some Progress Being Made
The report also highlighted areas of progress in reducing cancer care disparities and specific recommendations for achieving health equity.
The disparity in the overall cancer death rate has narrowed from 33% higher for African Americans compared with whites in 1990 to 14% higher for African Americans in 2016.
“Even more encouragingly, the disparity in the overall cancer death rate between African Americans and whites has been nearly eliminated among men younger than 50 and women ages 70 or older,” according to the report.
Dr Carpten touched on possible differences in cancer biology and the genomic underpinnings of cancer onset between races and ethnicities, but limited knowledge of these differences diminishes the potential of precision medicine in these populations.
Research initiatives such as the AACR Project Genomics Evidence Neoplasia Information Exchange are beginning to focus on cancer in all ethnic populations. Such initiatives and insights obtained by new research models and biospecimens may help to bring precision medicine to all patients with cancer, the report noted.