Cancer screening, treatment, and outcomes differ by racial category and geographic location
Cancer doesn’t affect all people the same. African Americans, Latinos, and other minority populations suffer a disproportionate burden of morbidity and death from cancer. Rural populations also suffer from an unequal burden from this disease.
In a report released on April 28, 2011, the President’s Cancer Panel identifies an urgent need to improve our understanding of the social factors that influence cancer risk and outcomes among minority and rural populations. The Panel’s report, “America’s Demographic and Cultural Transformation: Implications for Cancer,” states that current knowledge of cancer risk, incidence, progression, and outcomes is based largely on studies of non-Hispanic white populations. Therefore, the current understanding of risk factors, screening guidelines, and treatment may not be appropriate for individuals of non-European descent. The Panel also calls for higher standards of “cultural competence” among healthcare professionals to better address cultural and language barriers that can negatively impact the quality of patient care.
The President’s Cancer Panel made several key findings and recommendations:
• While the effects of socioeconomic and sociocultural determinants of health outcomes have long been recognized, cancer research has focused primarily on using genetics to identify health differences. The Panel recommends that both biological and sociological factors be examined to truly understand racial, ethnic, and geographic health disparities.
• The Panel identifies a need to evaluate current cancer screening guidelines to determine their accuracy in assessing disease burden in diverse populations. In particular, the report recommends that researchers consider the patient population in its entirety and identify common genetic, sociological, and environmental risk factors on which to base screening recommendations.
• Researchers must examine the effect of changing demographics and expand the current understanding of related factors that influence cancer risk, incidence, and mortality. This knowledge must then be applied for the benefit of all subpopulations so that more accurate preventive measures can be implemented.
• The majority of health care providers do not adequately consider patient sociocultural and socioeconomic characteristics when addressing cancer prevention and treatment, even though these factors can have independent and sometimes profound effects on cancer susceptibility and outcomes in both native and foreign-born Americans. In addition, the Panel found that patient-provider language differences are a significant barrier to the provision of quality health care. The Panel recommends that cultural competency become an integral part of medical and research training curricula, as well as a continuing education requirement. The Panel also recommends that trained interpreters be viewed as essential members of the health care team.
• The Panel says that, although personalized medicine for all is the ultimate goal in cancer care, it is not universally feasible or affordable in the near future. Therefore, research is needed now to identify subpopulations at high risk of disease due to genetic/ancestral, biologic, sociocultural, and other factors that directly relate to risk or response to therapy.
• Weaknesses in existing vital statistics, census, public and private insurer, and cancer surveillance data may thwart efforts to characterize populations in a scientifically meaningful way. To address these serious data deficiencies, the Panel calls for improvements in data collection, as well as standardized data sets and definitions of race and ethnicity.
• There is a need for improved data sharing among government agencies at all levels as well as a need to address issues of data compatibility.
• Additional recommendations include increasing the diversity of the cancer research and care workforces; exploring and evaluating the benefit of patient navigation models; and continuing basic, translational, clinical, population, and dissemination research on cancer health disparities.
The Panel concludes that cancer and other health disparities will be eliminated only when the social determinants of poor health outcomes, such as poverty, low educational attainment, substandard housing and neighborhoods, and insufficient access to quality health care, are adequately addressed.
I couldn’t agree more, and I’ve used this blog to make many of these same points. I hope this report by the President’s Cancer Panel will lead to increased funding of research on the social determinants of cancer health.