African Americans have the highest incidence of and death rates from cancer,1 which is also the leading cause of death in Hispanics.2 Cancers of the lung, prostate, and breast now produce higher death rates among minorities.2
More than a decade after federal legislation focusing on reducing health disparities created the National Center for Minority Health and Health Disparities, such disparities continue to persist, with people of color experiencing an earlier onset and a greater severity of negative health outcomes.1
“Simply put, health disparity is an inequity in health care and health care outcomes in terms of doctors relating to race, gender, and socioeconomics,” Sandra L. Wong, MD, MS, Chair-elect of the American Society of Clinical Oncology (ASCO) Health Disparities Advisory Group told Chemotherapy Advisor. ASCO has identified four key areas of disparity in cancer care: prevention, diagnosis, treatment, and outcome.
The National Cancer Institute defines cancer health disparities as “differences in the incidence, prevalence, mortality, and burden of cancer and adverse related conditions that exist among specific population groups in the United States.”3
What determines the type of care a patient with cancer receives is multi-faceted: in addition to race, gender, and socioeconomics, there is also genetics, age, education, language, residency, culture, marital status—and, most importantly, access.
“Rendering high-quality cancer care is impossible if you cannot ensure everyone has that care,” added Dr. Wong, Associate Professor of Surgery at the University of Michigan, Ann Arbor, MI.
The first comprehensive report to document that racial and ethnic minorities had less access to health care and, of what was accessible, was often poor quality, was the Institute of Medicine (IOM)’s 2003 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.4
Since then, countless studies have teased apart various components of health disparities among patients with cancer, from disparate rates of specific cancer types among people of color, to the role of patient navigators to ensure coordination of care, and to the effect of cultural support among immigrant populations.
“There’s been a lot of discussion about genetic differences and outcome disparities,” said Otis Webb Brawley, MD, Chief Medical Officer and Executive Vice President of the American Cancer Society. “What’s true is when you look at black women, 30% have HER2/neu-negative breast cancer, and only 20% HER2/neu-negative breast cancer in white women. Essentially, we’re talking about triple-negative breast cancer, but I emphasize HER2/neu-negative because there’s no racial difference in ER-negative or PR-negative.
“Frequently when I hear about it, it seems like a much larger difference, but it’s really only a 10% difference in triple-negative disease. Some people have wondered, ‘what it is about women of African heritage that leaves them prone to triple-negative breast cancer?’ But European studies show that women who grow up in poverty tend to have more triple-negative disease. In Scotland, they ask, ‘what is it about poverty that causes triple-negative disease?’ Here in the US, we ask, ‘what is it about race?’”