Presidential Panel Calls for Research into Cancer Disparities
Article date: April 29, 2011
By Melissa Weber
The number of minorities with cancer will likely double by 2030, and the nation’s cancer agenda needs to adapt accordingly, says a report released Thursday by the President’s Cancer Panel.
Minority and other underserved populations (such as inner city or rural poor) are often disproportionately affected by cancer in terms of risk, early detection, treatment, and survival. Understanding why – and developing strategies for leveling the playing field – were key objectives of the panel, which reports to the president on critical issues affecting the war on cancer.
“The changing demographics in America are going to have a significant impact on what cancer looks like in the future,” says panel member Margaret L. Kripke, PhD, of M.D. Anderson Cancer Center. “Both cultural and socioeconomic factors contribute to cancer outcomes, and I think we’re only beginning to recognize how significant those factors are in terms of the cancer disparity issues.”
A Different Approach
Most of what’s known about cancer—how it develops, progresses, and how to fight it—comes mainly from studies of whites. The one-size-fits-all approach to cancer screening, prevention, and treatment doesn’t work for diverse populations, the report says.
To fill the gaps, recommendations from the panel include more research, evaluation of current screening guidelines, standardized definitions of race and ethnicity that describe different populations in a more meaningful way, trained translators for patients who don’t speak English, and cultural competency training for health care providers.
“It is clear that a significant portion of the American population, however one defines them, is currently not receiving adequate cancer prevention and adequate cancer treatment,” says Otis W. Brawley, MD, chief medical officer of the American Cancer Society.
Indeed, data highlighted in the report show that African-American men are 50 percent more likely than white men to be diagnosed with prostate cancer. African Americans are also nearly twice as likely as whites to be diagnosed with colorectal cancer before age 50, and African-American women are more likely to die of breast cancer despite white women having the highest incidence rate.
For Latina women, breast cancer is more likely to strike at a young age, Kripke says. “So if they follow the current guidelines for mammography, we’re likely to miss a significant number of breast cancers in those women,” she says.
Compared to whites, Latinos also have a higher risk of getting and dying from stomach, liver, and cervical cancers, all of which are linked to infectious agents.
The panel acknowledges, however, that lifestyle, poverty and education may have more to do with cancer disparities than race and ethnicity. “The report clearly points out that race is a social and not a biologic construct, a point few Americans understand,” says Brawley, who cautions that although genetics plays a significant role in cancer, it’s not the whole story. “We must not let that blind us from seeing other factors at work here,” he says.
Not Just About Race
Cultural and lifestyle differences also play their part. In some cultures, for instance, women may delay seeking care because they’re reluctant to put their own needs ahead of their family priorities, the report says. Native American patients may want to incorporate traditional healing practices into their treatment plan, and people raised in rural cultures may refuse to go to the doctor unless it’s an emergency.
“In order to advance our control of this disease we must understand the role that culture, habits, and environment play in cancer causation and the cancer treatment experience,” says Brawley.
This is where cultural competency comes in, Kripke says. “It’s understanding the point of view of the individual you are communicating with or treating in terms of their different ideas and beliefs and background. It’s critically important that the medical profession be able to understand some of those cultural overtones and deal with them in a very sensitive way.”
Enter the Health Care Law
Much of the report had already been finalized before the Patient Protection and Affordable Care Act was signed into law last year, the panel noted in an addendum. “In addition to increasing health care access, numerous other provisions of PPACA either directly address or potentially facilitate implementation of the Panel’s recommendations in this report,” they note, adding that the report can serve as guidance for implementing certain provisions of the law.
The progress made in reducing the burden of cancer could be at stake without the necessary follow-through to break down racial and cultural barriers, Kripke says. “If you don’t address the factors that contribute to excess mortality in different ethnic populations, you will never be able to reduce mortality from cancer, which is really the goal.”
The American Cancer Society has funded more than $113 million in research aimed at reducing cancer disparities. In addition, the Society is currently enrolling adults from various racial and ethnic backgrounds to participate in the Cancer Prevention Study-3. The study will help identify the genetic, behavioral, environmental, and lifestyle factors that cause or prevent cancer.
To read the full report from the President’s Cancer Panel, visit pcp.cancer.gov.
Reviewed by members of the ACS Medical Content and News Staff
“America’s Demographic and Cultural Transformation: Implications for Cancer.” Released April 28, 2011 by the President’s Cancer Panel, 2009-2010 Annual Report.
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