The American Association for Cancer Research has released its annual AACR Cancer Disparities Progress Report to Congress, which details cancer health disparities affecting racial and ethnic minorities, low-income people, and the LGBTQ+ community. In this year’s report, researchers found that the medical community is not doing enough to reach out marginalized populations to discuss new advances in treatment and technology, leading to some alarming results.
While the study found that cancer rates are lower in the Black community than in white communities, Black people have higher cancer mortality rates than any other racial or ethnic group. The study also found that cervical cancer rates are 56% percent higher in Native American and Alaska Native women than white women, and that cancer is the leading cause of death for Asians living in America. Compared to the white population, researchers found that Native Americans and Alaska Natives have an 80% higher chance of developing kidney cancer, Latinx people are twice as likely to die from liver cancer, and Native Hawaiians and Pacific Islanders have nearly three times the mortality rate from stomach cancer.
“We hope this report can provide valuable information to Congress to support some of the bills that are up for consideration,” said Dr. Mariana Stern, one of the authors of the study, in an emailed statement.
Cancer in the LGBTQ+ community
Despite comprehensive data on how cancer impacts communities of color, limited data exists on the cancer disparities amongst LGBTQ+ people, leading to gaps in understanding how cancer affects them. Most of the data on LGBTQ+ people comes from small observational studies, so to help bridge these gaps, AACR cancer study participant Simone Saint Laurent said doctors should consider asking patients about their sexual orientation, pronouns, and gender identity on medical intake forms.
“I think you can reduce the anxiety of the patient, and they may actually listen and hear you,” Laurent said. “If you feel seen and feel heard, you probably can be a better participant in your treatment plan.”
Though data is limited, researchers noted that LGBTQ+ people do face implicit bias and discrimination by health care providers. Researchers also say there needs to be more research on the presence of breast and cervical cancer in trans people to understand the ways in which the community is affected, especially since trans men are more likely to object to cervical cancer screenings.
Structural inequities lead to cancer
For those familiar with America’s history of systematic racism that has seeped into the health care system, these statistics are no surprise. A person’s socioeconomic status, education, environment, career, and even their social networks can all have an impact on a person’s or community’s overall health.
Uninsured patients, under-funded hospitals, and high-priced prescription medications are just some of the factors that lead to structural and social inequities that can factor into mortality rates. Research also suggests that chronic poverty is also linked with higher rates of cancer deaths.
In a June 8 virtual congressional briefing about the report, Stern went over the different factors that contribute to the development of cancer, the largest one being the use of tobacco products. Tobacco use is the number one cause of cancer and death from cancer.
In the same virtual briefing, New York-based 50-year-old Sandra Morales explained some of the financial challenges that low-income Latinx women face when they deal with a serious illness like cancer.
“I know a lot of Latina women who have been diagnosed, but they are the breadwinners of their families,” said Morales, who was diagnosed with stage III breast cancer in 2010, in the report. “If they go for their treatment, they don’t work enough hours to have their insurance. And if they don’t keep on paying the rent, how can they continue living? It’s very hard.”
Research in the report backs this up. Follow-up care, for instance, is less likely to occur in marginalized communities because of lack of insurance, bias in the health care system, and miscommunication with providers. Black and Latinx patients might resort to cost-saving measures such as skipping medications because they experience financial strain twice as much as white patients.
The AACR has several recommendations for how to help vulnerable people living with cancer. Since the COVID-19 pandemic highlighted the need for widespread high-speed internet access to access telehealth options, the AACR recommends the expansion of internet access to rural and low-income urban communities through federal and local government funding. The benefits of telemedicine include increased access to health care, as well as improved health outcomes and reduced costs associated with traveling to and from hospital visits.
Short of eradicating racism and systemic injustice altogether, experts who developed the report have also pinpointed one big focus to closing the cancer disparities gap. They called for more people of color and those living in rural areas to participate in clinical trials to identify potential issues with medications, as well as studying the efficacy of new surgical tools and techniques in cancer treatment. Moreover, studying the genetic profiles of diverse candidates can help improve understanding of ancestry-related differences in biology.
America’s legacy of medical experimentation on Black and brown people like the Tuskegee experiment has left lingering fear and distrust of the health care industry and has resulted in a lack of willingness to participate in medical trials at all. The report suggests that more community outreach and engagement in underserved communities is needed to fuel participation of these population groups. They suggest health educators deliver presentations at churches, town halls, and other community health centers frequented by Black and Latinx people.
People can see which clinical trials they qualify for by going to clinicaltrials.gov.
“A good strategy is to check with the cancer center closest to where someone lives to find out if they have a trial open. Usually, cancer centers list their open trials on their websites,” Stern said.
In addition to medical trials, researchers also encourage BIPOC cancer patients to be sure to stay on top of their medication, since people of color are more likely to need to resort to “financial coping behaviors” like skipping doses of their medication in order to save money.