Wednesday, April 23, 2014

Addressing Imbalance: The facts behind the cancer treatment disparity

Cancer mortality rates are on the decline. They have been for some time. Over the past 40 years, the number of cancer survivors has quadrupled, climbing from three million to 12 million over the course of two generations. Fewer people are dying from breast, colon, lung, and prostate cancer – the four most commonly diagnosed cancer types. Between 2000 and 2009, cancer mortality rates fell an average of 1.8 percent a year for men and 1.4 percent a year for women.

But those statistics don’t tell the whole story. As encouraging as they are, they mask a disturbing trend – an ever-widening gap in survivorship between blacks and whites. While mortality rates do continue to fall, they have not fallen as fast or far for blacks. There is, particularly in specific cancers, a real disparity.

Mortality rates are higher for blacks diagnosed with breast, lung, colon, liver, stomach, prostate, and cervical cancers.  In Georgia, more than two times as many black women die from breast cancer as white and three times as many black men die from prostate cancer as white. In Georgia, blacks have a 43 percent higher death rate from colorectal cancer as their white counterparts.

The statistics are sobering and the solutions, both social and scientific, are not simple.

But we’re working on them.

The GRU Cancer Center has the only National Cancer Institute (NCI) Minority-Based Community Cancer Oncology Program in Georgia and is one of only 16 in the United States. We have made it our business to investigate the causes of cancer disparity and, more significantly, come up with suitable solutions. Social research has shown that a lack of health care coverage and convenient access to facilities have played a part, as late diagnosis statistics are significantly higher in both rural and lower socioeconomic communities. The higher statistical occurrence of high-risk behaviors, such as smoking, in the black community also plays a part.

But so too does biology.

According to the United States Census Bureau, approximately 13.1 percent of the American population is black and 37 percent of the population is a race or ethnicity other than white. Despite this fact, white patients account for more than 88 percent of participants in clinical trials. The Cancer Genome Atlas, a program instituted by the National Cancer Institute to collect, analyze, and catalog genetic material from the widest possible array of cancer patients has collected samples from 5,355 white patients, 439 black patients, and 191 Hispanic or Latino patients. This is not representative of population numbers and even if it was, it wouldn’t be enough because cancer affects different ethnicities and races in different ways, specific trials must be developed, with large sample sizes, to determine, once and for all, how these patients are affected by both the disease and treatment.

But simply building accurate research models is not enough.  Collecting the proper data, both in quantity and quality, to determine the causes for specific cancers and the ways they affect a diverse population is essential. It’s that data that’s required to start constructing a cure, to start building focused programs that directly address disparity in cancer diagnosis, care, and treatment.

And so we, as a community of scientists, continue to make this mission a priority and we will continue to directly address the specific needs of underserved populations.

It’s the right thing to do – for everybody.

Dr. Samir N. Khleif has more than 22 years’ experience in cancer research and treatment, including in the Cancer Vaccine Section at the National Cancer Institute. The GRU Cancer Center is working toward becoming a National Cancer Institute-designated cancer center.

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