Unequal Cancer Burden
Article date: April 1, 2008
Disease's Toll Worse for Minorities, Medically Underserved
Cancer disparity is a real issue that's full of stark truths. For instance, data show that racial and ethnic minorities and medically underserved groups are more likely to develop cancer, and die from it, than the general US population.
Research also shows that uninsured patients are more likely to be treated for cancer at late stages of disease, and they're more likely to receive substandard care.
"It's really a major concern," says Ronit Elk, PhD, the American Cancer Society's director of research targeted at the poor and underserved. "Everyone needs to have access -- equal access -- to optimal care."
The American Cancer Society, along with a number of other nonprofit groups, public service agencies, professional associations, and academic centers, is looking into the underlying factors involved in cancer disparity. The overall goal is to better understand the problem and then draft real-world solutions to improving access to cancer information, disease screening, and treatment options within minority communities.
Plenty of obstacles remain, according to Durado Brooks, MD, MPH, director of prostate and colorectal cancer for the American Cancer Society. "Unfortunately, for a variety of reasons -- including access to quality health care -- these population groups have not benefited equally from advances in cancer prevention, early detection, and treatment," he says.
This inequality is the focus of a section on cancer disparities in the Society's Cancer Facts & Figures 2008. In it, the authors conclude: "Racial and ethnic minorities tend to receive lower quality health care than whites even when insurance status, income, age, and severity of conditions are comparable." The authors note that minorities face many obstacles, including lack of health insurance, living in rural or inner-city communities, having low incomes, and experiencing language barriers, racial bias, and stereotyping.
Unequal Access, Disproportionate Cancer Deaths
The disparity in cancer prevention, treatment, and survival grows clearer each year.
Cancer death rates for African-American men are about 37% higher than those for white men, while death rates for African-American women are about 17% higher than for white women, even though African-American women have lower cancer incidence rates than white women.
Unequal access to screening, timely diagnosis, and treatment is part of the problem, says Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society.
"Many people who need to be screened for cancer, whether it be mammography, cervical cancer screening, or colorectal cancer screening, either aren't taking advantage of the opportunity or don't have the opportunity," Lichtenfeld writes in Dr. Len's Cancer Blog.
A special section in Facts & Figures 2008 examines this issue and confirms that lack of insurance is an important barrier to cancer prevention and early detection as well as effectively coping with the costs of cancer treatment.
Cost can be a deterrent even when the patient is insured, according a recent New England Journal of Medicine study that found many women skipping mammograms because of the difficulty in making the required copayments -- even when those copayments were under $15.
"This new study [shows] that not only having no insurance but also having coverage that requires a copayment can reduce the chances of appropriate screening behavior," says Otis Brawley, MD, chief medical officer for the Society. "While the amount of copayment would not seem terribly high, the study indicates it is enough to make some women avoid getting mammography, which is proven to save lives from breast cancer. Recent surveys have shown a troubling drop in the use of mammography, but the reasons behind the drop have not been well understood. This study lends credibility to the idea that access to affordable health care is a very real factor."
Access to Care Campaign
The issue of access to health care has become so critical in the fight against cancer that the American Cancer Society in September launched an unprecedented campaign to highlight the problem. National advertisements urged reform by calling attention to the difficulties faced by people diagnosed with cancer when they had no health insurance or too little insurance to cover the costs of their care.
While the Society does not endorse any particular plan for healthcare reform, ACS and its sister organization, the American Cancer Society Cancer Action Network (ACS CAN), developed 4 principles that should define healthcare coverage in the US:
- Adequate: People must have timely access to the full range of health care, including prevention and early detection.
- Affordable: Health care costs should be based on the patient's ability to pay.
- Available: People need to have coverage no matter what their health status is or what treatments they've had in the past.
- Administratively simple: Health care processes should be easy to understand and navigate.
The Access to Health Care initiative is merely the latest in a long list of efforts undertaken by ACS to address the cancer disparities among racial and ethnic minorities and the medically underserved.
The Society has long funded research to discover culturally relevant prevention tactics, early detection measures, and effective ways to provide equal access to optimal care for underserved populations. And through its Patient Navigator Program, ACS provides trained staff in dozens of hospitals in underserved communities throughout the US to help cancer patients by arranging transportation to and from treatment, providing referrals to local services like physical therapy or nutrition counseling, or finding information on financial assistance programs.
'We Need To Do Better'
Health care providers sometimes don't recognize cancer disparities, don't know the data, or have yet to take adequate steps to address differences in their screening and treatment routines.
For example, a study of 1,690 melanoma patients found that African-American and Latino men are 30% less likely to survive the cancer than white men are. The reason? Skin-screening programs tend to be targeted at whites, so darker-skinned men are less likely to be screened and less likely to be diagnosed early, according to the study, published in 2006 in the Archives of Dermatology.
"We need to do better. We spend over $2 trillion on health care in this country every year, and yet lives are being lost for the most simple and basic lack of medical care," Lichtenfeld writes in his blog.
Reviewed by: Members of the ACS Medical Content Staff
ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases.
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