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The Fight for Equitable Cancer Care in African American Communities: It starts by recognizing cancer disparities unique to each population.
The Fight for Equitable Cancer Care in African American Communities: It starts by recognizing cancer disparities unique to each population.
February is Black History Month, making this an important time to note the racial disparities that exist in cancer care and research. Race is an underlying determinant that can put certain populations at higher risk of being diagnosed with certain cancers.
Because of the genetic makeup of tumors, cancer affects individuals differently. Other factors that alter the way an individual experiences cancer besides sex and gender include lifestyle, geography and income among others. These are explained as the social determinants of health or, more specifically, cancer disparities.
African Americans are part of one of the largest minority populations in the United States. This group also reports the highest cancer mortality rate, despite the decline in cancer incidence rates, of any other racial population. These striking statistics have become the basis for the drive across the healthcare industry to implement initiatives to reduce healthcare disparities and ensure every individual has equitable access to the care they need to treat their disease at every stage.
For example, black people have higher death rates than members of all other ethnic groups for certain types of cancer, specifically multiple myeloma and prostate cancer. Additionally, black women are more likely to be diagnosed with breast cancer, triple-negative breast cancer and inflammatory breast cancer. Furthermore, they are at higher risk for developing lung and colorectal cancers. Black men are diagnosed more often with lung and bronchus cancer as well as prostate, colon and rectum cancers than other populations.
Here are three facts about cancer among the African American population.
This population reports a lower cancer screening rate compared to their counterparts. Frequent cancer screenings, as recommended by physicians, can help detect tumors in the early stage and before they have had time to develop. As a result of both delayed and no screenings, late stage diagnoses are more common, which has allowed time for the tumor to develop and spread. The higher rate of inaccessible and quality healthcare services and being uninsured as well as an increased level of medical distrust are only just a few reasons why screenings are low for this population.
The five-year survival rate for certain cancers is lower for African Americans. Cancer is often found in advanced stages that are more challenging to treat, which increases the risk of mortality. In fact, black men have a 19% higher mortality than white men, and black women have a 12% higher mortality rate than their counterparts. The survival rates are impacted by the barriers to timely care and accessible cancer treatment centers in addition to other cancer disparities.
There is an underrepresentation of African Americans in clinical trials. Diversity in cancer treatment trials is critical in learning how certain therapies impact specific populations. However, African Americans are less likely to be participants in these studies for various reasons including economic factors, unawareness of available trials and mistrust. Diversifying the participants who enroll in trials provides insights into the efficacy of treatments.
Early detection through frequent screenings makes a difference in whether cancer therapies are successful or not. By recognizing the disparities populations face, such as the African American community, physicians and healthcare teams can work toward creating more inclusive services that enhance the health and well-being of many.
The Causes of Racial Disparities
There are many reasons why racial disparities exist in cancer care, one of which is based on socioeconomics. The reality is that a wide wealth gap remains between black and white households, even within the same income class, which can put higher-quality medical care out of financial reach. This is especially true for those seeking treatment for costly cancer care.
Another reason is the inherent distrust African Americans have traditionally had with the healthcare industry. While this distrust dates back to the highly unethical Tuskegee syphilis study in 1932, more recent research has provided additional reasons why it persists: an implicit bias in healthcare that black people often receive lower quality care than their white counterparts. According to a survey conducted by Genentech and published by WebMD in partnership with the All of Us Research Program, one in three medically disenfranchised black and Hispanic people said they didn’t participate in clinical trials or receive vaccinations because of their lack of confidence in the healthcare industry.
The restoration of trust in the healthcare industry would be a huge step forward in greatly reducing or eliminating racial disparities.
The Need for Diversity in Research
While social and economic barriers do play a role in higher rates of cancer in the United States, it is also true that African Americans are more susceptible to the disease than other ethnic groups. This can be attributed to genetics, limited access to quality care and, most importantly, substandard care stemming from a lack of diversity in clinical research and drug trials.
Black people make up about 13% of the U.S. population, yet we seldom see that portion of the population represented in research. Notably, African Americans make up just 1% to 2% of the participants in clinical trials. This lack of diversity makes it impossible to see what effect certain drugs may have on people of African American descent, especially when trying to treat multiple myeloma, of which African Americans account for approximately 30% of the patients.
One way to combat this is to assign a diversity officer to all research studies and clinical trials. Currently, there are data safety and monitoring boards for studies to ensure the patients and participants are being properly cared for and protected. The diversity officer can play a similar role by ensuring study populations don’t heavily skew in the direction of one race or another. This helps ensure that all patients are represented equally, making available the data that lets researchers know the effect a certain drug or treatment has on all members of the population.
Steps in the Right Direction
Disparities and gaps in care do exist, but for the first time, we are seeing progress toward rectifying this problem. While the Food and Drug Administration cannot mandate population-based studies, it is beginning to encourage drug manufacturers and the healthcare industry to focus research on generating data applicable to African Americans. The industry seems to be listening, too, as evidenced by the creation of think tanks and advisory boards to learn how to be more inclusive.
The American Society of Clinical Oncology, which is the world’s largest cancer society that features representation from 150 different countries, recently announced the addition of a diversity and inclusion officer to its administrative structure. This role will address some of these racial disparities and work toward solutions to eliminate them.
At American Oncology Network (AON), we are in a unique position because of our diverse patient population and geographic footprint. This combination allows all patients, but especially African Americans, to participate in trials right in their community – trials that are being conducted by physicians and doctors they know and trust.
This sort of inclusion is a significant step toward making sure patients from all walks of life are receiving the care they deserve.
To read more blog articles developed by AON and its physicians, visit www.AONcology.com/blog/.
Note: This article has been adapted from two articles published on the American Oncology Network blog: “Three Facts About Cancer in African American Communities,” authored by AON, and “Racial Disparities in Cancer Care and Research: The Causes and Possible Solutions,” authored by AON’s Board-certified medical oncologist Ruemu E. Birhiray, MD, a physician at Hematology Oncology of Indiana and member of AON’s diversity committee.
