AACR report on cancer disparities reveals harsh truths and a call to action

The American Association for Cancer Research (AACR) released its inaugural Cancer Disparities Progress Report today describing a devastating gap in cancer treatment and outcomes due to race, ethnicity, socioeconomic status, sexual orientation and more. The report also includes a special section on COVID-19.

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Rick Kittles, Ph.D., Director of the Division of Health Equities in the Department of Population Sciences at City of Hope (Photo: City of Hope)

On the steering committee for this important report was City of Hope’s Rick Kittles, Ph.D., director of the Division of Health Equities in the Department of Population Sciences. Kittles, an expert in genomic research, has long focused on understanding the complex issues surrounding race, genetic ancestry and health disparities.

Of major concern is the group most affected by these inequalities: the African American community.

“It’s not OK that in the U.S., African Americans have had the highest overall cancer death rate for more than four decades,” Kittles said. “We need to recognize the systemic, gross health disparities in our nation, health care system and medical research, which does not have enough representation from the Black community.”

The report details the disparities for African Americans as well as many other groups, highlights areas where some progress has been made, and lays out the paths toward significant solutions.

Some shocking statistics

These statistics provide some enlightening examples of what the report found — and the discrepancies are dramatic.

• African American men have a 111% higher risk of dying from prostate cancer than white men.
• African American women are 39% more likely to die from breast cancer compared to white women.
• Asian/Pacific Islander adults are twice as likely to die of stomach cancer than white adults.
• In the poorest U.S. counties, men with colorectal cancer have a 35% higher death rate than men in the most affluent counties.
• Bisexual women are 70% more likely to be diagnosed with cancer than heterosexual women.

The statistics are equally telling for COVID-19, with hospitalization and mortality rates enormously higher among people of racial and ethnic minorities than among the white population.

Some progress toward closing this health gap has been made. In 1990, the cancer death rate for African Americans was 33% higher than the death rate for white people. In 2016, it was 16% higher. An improvement, yes — but still a huge discrepancy.

As with everything related to cancer, the factors contributing to these disparities are complex. Some may be genetic; some are related to gaps in medical research due to lack of diversity among study subjects and others are lifestyle choices that can be modified for better health outcomes.

Some risk factors can be reduced

The risk for about 40% of adult cancers can be reduced when people modify certain behaviors — tobacco use, excess body weight, lack of exercise, alcohol consumption, and sun and UV exposure.

Regular screening for breast, cervical, colorectal and prostate cancers — as well as certain strains of cancer-related human papillomavirus — are also important, but these screenings are less likely to occur among the groups studied.

The report calls for new strategies in education and intervention to reduce the incidence of cancer in the U.S., while a deeper look at the problem also revealed more complicated issues.

Socioeconomic status and cancer

The report also examines the question of socioeconomic status and cancer — an area that often overlaps with racial and ethnic minorities. It’s a subject Loretta Erhunmwunsee, M.D., a City of Hope thoracic surgeon, has studied extensively.

Her research has shown how socioeconomic status, high-poverty neighborhoods and low educational levels are all linked to higher death rates in certain types of cancers.

“Social factors have a significant impact on cancer health disparities. The report reminds us that up to ‘34% of cancer deaths could be prevented if socioeconomic disparities were eliminated.’ This finding suggests that we must address social determinants if we are going to eliminate disparities,” she said.

Her work has also proven that these factors directly affect cancer outcomes.

“Research has shown that individuals living in disadvantaged neighborhoods are more likely to be diagnosed with late-stage cancer and to have poorer survival compared with individuals in more advantaged neighborhoods,” Erhunmwunsee explained. “We therefore have to consider our patients’ physical environment and their exposure to pollution as we care for them. Ignoring these factors will contribute to worsening disparities.”

Further inequities in treatment and research

Apart from the impact of socioeconomic factors in accessing screening and health care, there are issues directly related to treatment and research that need to be addressed.

Enormous breakthroughs are now being made in cancer research — many involving new precision medicine based on biological, environmental and lifestyle factors unique to each individual patient.

Like all advances, these are based on scientific studies. The report points out, however, that the subjects for most of these studies are white, so that the genetic differences of minorities are often not considered.

This is one of the areas Kittles is working hard to change.

“We are now able to genetically screen many tumors and use the information to make better clinical decisions for patients. Yet, the majority of the data on cancer-associated mutations come from white people,” he said. “So many of these breakthrough new treatments may not be as effective for Black people and Latinos, who arguably need it more than other groups to continue to close the health disparity gap.”

Fortunately, the patient population at City of Hope is quite diverse, composed of people from many different ethnic backgrounds, providing an excellent pool of subjects for the many advanced studies that take place here.

The full AACR report can be accessed at cancerprogressreport.aacr.org/disparities/.

About City of Hope

City of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threatening diseases. Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin and numerous breakthrough cancer drugs are based on technology developed at the institution. A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope has been ranked among the nation’s “Best Hospitals” in cancer by U.S. News & World Report for 14 consecutive years. Its main campus is located near Los Angeles, with additional locations throughout Southern California. For more information about City of Hope, follow us on Facebook, Twitter, YouTube or Instagram.

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