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A call for health equity for all

The American Association for Cancer Research (AACR) has released its inaugural Cancer Disparities Progress Report, which aims to raise awareness of the disproportionate impact of cancer on racial and ethnic minority populations. The report highlights areas of progress in reducing these disparities and provides recommendations on how to achieve health equity for all.

A basic human right

The ongoing COVID-19 pandemic has had a disproportionate effects on minority communities. In recent years, cancer research discoveries have generated a lot of excitement due to their translation into improved diagnosis, treatment and patient outcomes. Nevertheless, the reality is that progress in the fight against cancer has not benefited everyone equally. There is a disproportionate impact on particular populations (cancer health disparities). The simultaneous COVID-19 burden on racial and ethnic minority populations reinforces the bleak inequities in healthcare. Disparities within healthcare represent the most significant forms of inequality and injustice. Therefore, it is vital that everyone plays a role in eradicating these social injustices that prevent people from accessing healthcare – a basic human right.

Cancer health disparities

Last month, AACR released two articles investigating the impact of COVID-19 on cancer patients. The papers demonstrated the importance of considering demographic factors in cancer care. For example, they found that there was a link between higher risk of adverse outcomes and race/ethnicity. In their recent report, AACR have highlighted areas of progress in reducing cancer health disparities. They also emphasised the vital need for continued transformative research and increased collaboration towards the vision of health equity. In turn, this will ensure that research-driven advances benefit all, regardless of race, ethnicity, age, gender, sexual orientation, socioeconomic status or the community in which they live.

According to the report:
  • In the United States, African Americans have had the highest overall cancer death rate of any racial or ethnic group for over four decades.
  • The lowest colorectal cancer screening rate in the United States is in Hispanics, while the lowest breast cancer screening rate is in American Indians/Alaska Natives.
  • Complex and interrelated factors contribute to cancer health disparities. Yet, structural and systemic racism directly influence all of these factors.
  • As shown with COVID-19, racial and ethnic minorities are severely underrepresented in clinical trials. There is also a significant lack of understanding of how cancer develops in racial and ethnic minorities.
  • A lot of the US population experiencing cancer health disparities are also experiencing disparities related to COVID-19. This is particularly true for racial and ethnic minorities.
  • Experts predict that the pandemic will exacerbate existing cancer health disparities.

John D. Carpten, PhD, Chair of both the AACR Cancer Disparities Progress Report 2020 Steering Committee and the AACR Minorities in Cancer Research Council stated:

“This monumental report represents the collective effort of a number of the world’s foremost thought leaders in cancer health disparities research. It highlights progress but it also initiates a vitally important call to action for all stakeholders to make advances toward the mitigation of cancer disparities for racial and ethnic minorities and other underserved populations.”

Making progress for all

Estimates indicate that in 2020, there will be 1,806,590 new cases of cancer and 606,520 deaths. However, this burden is not equally shared amongst the US population. The differences in cancer burden in certain groups is a major public health challenge in the United States.

In the report, the authors discussed the progress in recent years in reducing these cancer health disparities. This included:

  • The differences in overall cancer death rates among racial and ethnic groups are less pronounced. For example, in 1990 overall cancer death rates for African Americans were 33% higher than in Whites. However, in 2016, it was only 14% higher.
  • Evidence has shown that if all patients had equal access to standard treatment, racial and ethnic disparities in outcomes for some cancer types could be eliminated.
  • Tailored outreach and patient navigation could help reduce disparities across cancer care.
  • Several projects are underway to address the gaps in our knowledge regarding cancer biology in diverse populations. This includes the AACR Project Genomics Evidence Neoplasia Information Exchange (GENIE) and the National Cancer Institute-funded African American Breast Cancer Epidemiology and Risk (AMBER) Consortium.
  • Diversity-focused training and career development programs over the past two decades have enhanced racial and ethnic diversity in cancer training.

A vital investment

Nevertheless, it is clear that progress has been slow. Most importantly, the cost of all health disparities, in terms of premature deaths, lost productivity and impact on minority communities, is colossal and must be addressed. The AACR emphasised that they are committed to working with all stakeholders to help overcome cancer health disparities. They ended the report with a call to action to policymakers and all stakeholders to end social injustices that are barriers to health equity. Specifically, they recommended that leaders:

  • Provide federal agencies and programs that aim to reduce cancer health disparities with robust, sustained and predictable funding.
  • Ensure implementation of steps into clinical trials to include a diverse population of participants.
  • Make sure that support programs are in place so that the healthcare workforce reflects the diverse communities it serves.
  • Prioritise cancer control initiatives that aim to reduce the incidence, morbidity and mortality of cancer and improve quality of patient life.
  • Work with members of the Congressional Tri-Caucus to pass the provisions included in the Health Equity and Accountability Act.

Margaret Foti, PhD, CEO of the AACR, stated:

“Health disparities in general, and cancer health disparities in particular, are an enormous public health challenge.

 We are immensely grateful to Dr. Carpten and the expert members of the Steering Committee for their hard work on this groundbreaking report, and are hopeful that it will serve as a valuable resource for policymakers, researchers and advocates who are deeply committed to eradicating cancer health disparities.”

Going forward

Cancer health disparities are an enormous public health challenge, particularly within the United States. Racial and ethnic minority populations have long experienced cancer health disparities and are now experiencing disparities related to the current pandemic. While some progress has been made to reduce these disparities, there still remains a disproportionately high number of overall cancer mortality within the African American population. Researchers have identified several factors that contribute to these disparities, all of which are related to systemic inequalities and prejudices. Many initiatives are now providing insight into the biological and genetic factors that contribute to cancer health disparities. To overcome these disparities, it is critical to enhance diversity amongst researchers and healthcare workers. In addition, leaders must develop science-based public policies to help advance cancer prevention and detect cancer early.

Access to quality healthcare is a basic human right. The purpose of a healthcare system is to ensure the health of its citizens. How can we progress when individuals are not getting access to basic healthcare? Lives are being lost unnecessarily. Change must not be in the future. Change must happen now.

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More on these topics

Cancer / Cancer Research / covid-19 / Equality