Slow Progress, but Many Disparities in Cancer Burden Persist

Cancer continues to exact a high and disproportionate toll on racial and ethnic minorities and other medically underserved populations in the United States, despite some progress in reducing disparities, according to the American Association for Cancer Research (AACR) Cancer Disparities Progress Report 2022.

"We are making progress against disparities across the cancer continuum," Electra Paskett, PhD, member of the steering committee for the report, told Medscape Medical News.

Dr Electra Paskett

"However, there are still disparities in incidence, mortality, access to healthcare and the latest medical advances among certain populations — mainly those from racial and ethnic minority, older and younger, socioeconomic, geographic location, and sexual or gender minority groups," she said.

"Research on understanding biology and systemic roots of disparities is needed, including more integration of the social determinants of health and their impacts across the continuum of cancer care," said Paskett, co-leader of the cancer control research program at The Ohio State University Comprehensive Cancer Center in Columbus.

Key findings in the new report on lingering cancer disparities include:

Both incidence and mortality rates for multiple myeloma in Blacks are at least twice as high as the rates in non-Hispanic Whites.
Hispanics individuals have a mortality rate of liver cancer that is nearly double that of non-Hispanic Whites.
American Indian/Alaska Native (AI/AN) people have an 80% higher incidence rate of kidney cancer compared with non-Hispanic Whites. AI/AN also have the highest incidence rate of liver cancer than any major racial or ethnic group in the United States.
Transgender men are more than twice as likely as cisgender men to be diagnosed with cancer.
Residents of low-income areas share a disproportionate burden of cancer mortality. For example, in persistently poor counties, morality rates are about 12% higher for all cancer types, and more than 40% higher for stomach cancer, compared with counties that are not persistently poor.
People living in rural areas have 17% higher death rates from all cancers combined when compared with urban dwellers, including 34% higher death rates from lung cancer and 23% higher death rates from colorectal cancer.

Slow but Steady Progress

Encouragingly, there is good news: Awareness of cancer disparities is increasing, and there has been slow but steady progress against these "persistent, pervasive, and unjust" inequities, the report notes.

For example, the disparity in overall cancer mortality rates between Blacks and Whites narrowed from 26% in 2000 to 13% in 2019.

Also, the expansion of Medicaid under the Affordable Care Act (ACA) has nearly eliminated the disparity between Blacks and Whites starting chemotherapy within a month of a cancer diagnosis, and the disparity between Hispanic and White women receiving timely mammograms.

In addition, cancer screening programs that adopt culturally tailored approaches and reduce structural barriers have been successful in improving screening rates among marginalized groups, thereby improving the likelihood of detecting cancer early, at a more treatable stage.

"Advances in screening and treatment have resulted in millions of cancer patients continuing to live long and productive lives, but efforts to make this progress equitably available to all population subsets continue to be inadequate," Lisa A. Newman, MD, MPH, chair of the steering committee for the report, said in a statement.

"We cannot achieve the ultimate goal of eradicating cancer as a life-threatening disease for all unless we comprehensively address the genetic, environmental, and lifestyle features that characterize the entirety of our diverse patient population," said Newman, chief of breast surgery, NewYork-Presbyterian and Weill Cornell Medicine in New York City.

Closing the Gap

Nonetheless, the "grim reality" is that the tremendous advances in cancer have not benefited everyone equally, the report authors emphasize.

Racial and ethnic minorities remain underrepresented in clinical trials and scientific understanding of how cancer develops in these groups is significantly lacking.

To address these gaps in cancer research and knowledge, the report recommends:

Diversifying patient accrual on clinical trials so that participants represent all potential patient groups who might benefit from the therapeutic being tested.
Creating large and inclusive genomic databases to increase our knowledge of the cancer-related changes that influence cancer incidence, progression, and response to treatment in patients from different ancestral groups.
Disaggregating cancer data to account for the heterogeneity of people within racial, ethnic, sexual, and gender minority groups.

A Call to Action

The report urges policymakers and other stakeholders to take the following actions:

Increase federal funding for medical research and public health initiatives that are tasked with reducing cancer health disparities; specifically, provide $49 billion for NIH's base budget in fiscal year (FY) 2023; increase funding for the National Institute on Minority Health and Health Disparities; and fund the National Cancer Institute at $7.766 billion in FY 2023.
Improve collection of disaggregated data for racial, ethnic, sexual, and gender minority groups and increase diversity in clinical trial participation.
Enhance cancer prevention and screening efforts to reduce the burden of cancer among all medically underserved populations, and expand access to equitable and affordable quality healthcare.
Build a more diverse STEMM (science, technology, engineering, mathematics, and medicine) trainee pipeline and cancer research and healthcare workforce.
Enact comprehensive legislation to eliminate racial and ethnic health inequities, specifically the Health Equity and Accountability Act (HEAA). (It was reintroduced this past April by Illinois congresswoman Robin Kelly.)

The full report is available online.

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