September 17, 2020 12:40 PM

‘The Immense Burden of Cancer is Not Shouldered Equally’

A first-ever report describes how overall gains against cancer are not benefiting some racial and ethnic groups – and how COVID-19 may be making it worse.

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While scientific discoveries have led to advances in how we prevent, detect, treat and survive cancer, these gains have not benefited everyone equally.

A new report from the American Association for Cancer Research highlights the impact of cancer health disparities and calls for transformative research, collaboration and committed funding to ensure research-driven advances benefit everyone.

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“The immense burden of cancer is not shouldered equally by all segments of the U.S. population,” the report states, calling this disparity “one of the most pressing public health challenges that we face in the United States.”

The report identifies multiple factors that have perpetuated cancer health disparities, including environmental, social, lifestyle, cultural and genetic factors. Access to quality health care is also an issue. Studies have shown giving all patients access to standard treatment would eliminate racial and ethnic disparities in prostate cancer or multiple myeloma.

In addition, the report describes similar racial and ethnic disparities in COVID-19 infections, and predicts the pandemic will worsen existing cancer health disparities.

“Putting a spotlight on cancer disparities, which many of us have observed for years, is needed. We hope we can reach the American public as well as policy makers that can lead to initiatives and policies that move cancer care towards equity. It takes a village,” says John M. Carethers, M.D., John G. Searle Professor and Chair of Internal Medicine at Michigan Medicine.

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Carethers, whose research within the Rogel Cancer Center looks at disparities in colon cancer screening and treatment, was on the steering committee that developed the report. He takes a deeper dive into the issue with Michigan Health Lab.

Why is a report like this that focuses on racial and ethnic disparities in cancer care so critically important?

Carethers: This is the first-ever report to Congress and the American public that specifically focuses on cancer health disparities. The American Association for Cancer Research (AACR) has published an annual update on cancer and research, but this is the first report that focuses on minority issues and cancer. This was conceived well before the current national issues on race, and was borne out over evolving and growing concerns from leadership and membership within AACR to provide an increased focus on disparities.

What highlights or key points from the report resonate in particular with you?

Carethers: I was involved in authoring three specific areas of the report: the state of cancer health disparities, COVID-19 and cancer, and diversity in training and the workforce. I think the specific sections on COVID-19, which was added to this critical report, and the highlight of disparities in cancer treatment and cancer survivorship resonate with me and will resonate with the readers of the report. We have to do better than what we are doing now. And the similarities between COVID-19 issues and cancer disparities is uncanny. The origins for both are the same.

The report references a narrowing in the gap for overall cancer death rates among racial and ethnic groups. What are some of the factors that account for that?

Carethers: Prevention is the best approach to any cancer regardless of background. Efforts made over the past one to two decades have helped narrow the gap. In the era of COVID-19, there is extreme worry that the gap could widen due to the unbalanced proportion of minorities affected by the infectious disease, setting back years of progress.

Can you provide an example from your own research that illustrates cancer health disparities or a potential opportunity to address disparities?

Carethers: Sure. I focus on colorectal cancer disparities, particularly in African Americans. My laboratory’s work has uncovered differences in levels of inflammation and subsequent DNA damage that might be a result of microbiome changes, which in itself largely are affected by the diet. In one sense, what we eat over our lifetime helps determine if you acquire colorectal cancer. Thus, lifestyle changes and healthy diets lower that risk. This has been known for some time, but can be challenging in the social and economic environment of some people – for example, those living in grocery store deserts without access to healthy fruits and vegetables. Screening for colorectal cancer can supplant differences, as long as you have access to screening and complete it.

Are you optimistic that we can achieve health equity?

Carethers: Yes, there is published evidence for colorectal cancer screening that this can be achieved – but with a lot of effort. The equity is that all have access to screening and complete it. The challenge for everyday situations is the access and completion part. As I mentioned, I am worried that COVID-19 might set us back on many of the gains we have made nationally over the past decade.