Cancer Disparities Progress Report 2022 Targets Ongoing Public Health Challenge of Health Equity

The release of the American Association for Cancer Research (AACR) Cancer Disparities Progress Report 2022 has continued to emphasize the major public health challenge in the United States surrounding cancer health, including higher incidences of cancers in minority groups and 3 times the mortality rate of specific cancers in those living in persistent poverty.

Social determinants of health (SDOH), which include social, economic, and physical conditions, have a major impact on people’s health, wellbeing, and quality of life. The presence of SDOH has caused numerous health inequities for racial and ethnic minorities and other medically underserved populations in the United States, according to the report.

Specific groups that experience greater cancer health disparities due to SDOH include:

• Individuals belonging to different ancestry, race, or ethnicity
• Individuals of low socioeconomic status
• Individuals who lack or have limited health insurance coverage
• Members of the sexual and gender minority communities
• Certain immigrants, refugees, or asylum seekers
• Individuals with disabilities
• Adolescents and young adults
• Elderly population
• Residents in certain US geographic locations, such as rural areas or specific territories

Compared to non-Hispanic White (NHW) populations, incidence and mortality rates for multiple myeloma in the Black population are at least twice as high, and the mortality rate for liver cancer in the Hispanic population is nearly double of the NHW population.

Residents of low-income areas also still experience a disproportionate burden of cancer mortality, with persistently lower income counties having mortality rates 12.3% higher for all cancer types and more than 40% higher for stomach cancer when compared to other counties that are not as persistently in the low-income bracket.

Additionally, for individuals who live in rural areas, there is a 17% higher death rate from all cancers combined, 34% higher death rates from lung cancer, and 23% higher death rates from colorectal cancer.

Furthermore, in comparison to cisgender individuals, individuals transitioning from female to male are 58% less likely to adhere to cervical cancer screening. Additionally, transgender men are more than twice as likely as cisgender men to be diagnosed with cancer.

“Advances in screening and treatment have resulted in millions of cancer patients continuing to live long and productive lives, but efforts to make this progress equitably available to all population subsets continue to be inadequate. Inequities such as disparate access to clinical research and optimal cancer care place vulnerable communities at risk for adverse outcomes and impair our ability to understand the root causes of cancer,” said Lisa A. Newman, MD, MPH, chair, AACR Cancer Disparities Progress Report 2022 Steering Committee and chief, Section of Breast Surgery, NewYork-Presbyterian and Weill Cornell Medicine in New York, in a press release.

Newman explained further that an inability to understand the root causes of cancer in some limits the ability to effectively eradicate cancer for all.

“We cannot achieve the ultimate goal of eradicating cancer as a life-threatening disease for all unless we comprehensively address the genetic, environmental, and lifestyle features that characterize the entirety of our diverse patient population. The AACR Cancer Disparities Progress Report 2022 explores these issues and provides an action plan for addressing them, which includes a blueprint for strengthening the diversity of our oncology workforce, so that we enlist the brilliance and creativity of individuals from all communities as allies in the war on cancer,” Newman said in the press release.

There are great breakthroughs happening in the tremendous research being conducted against cancer disparities, but there is still a major gap in racial and ethnic minorities who are severely underrepresented in clinical trials, as well as a lack of understanding of how cancer develops in these populations.

Some of the key steps that the report highlights as being crucial steps in cancer research and education include:

1. Creating large, inclusive genomic databases to increase knowledge of the cancer-related variations that influence cancer incidence, progression, and response to treatment in patients from different ancestral groups
2. Diversifying patient growth on clinical trials so participants from all patient groups who may benefit from the therapeutic being tested are represented
3. Disaggregating cancer data to account for the heterogeneity of people within racial, ethnic, sexual, and gender minority groups

The report also documented how, within these barriers, there has been some progress against cancer disparities that have occurred over the past few years. For example, the disparity in overall cancer mortality rates between Black and White populations has dropped from 26% in 2000 to 13% in 2019.

In terms of Medicaid, their expansion under the Affordable Care Act has nearly eliminated the disparity between Black and White populations starting chemotherapy within a month of cancer diagnosis, as well as the disparity between Hispanic and White women receiving timely mammograms.

Further, the likelihood of detecting cancer earlier for more patient success has immensely improved, with cancer screening programs being implemented to tailor approaches to cultural needs and reduce structural barriers among marginalized groups.

Real-world data from more than 121,000 patients in the AACR Project GENIE showed 13.4% of individuals were from racial and ethnic minority groups. To add to these efforts, the NIH also created the All of Us Research Program to build one of the most diverse health databases to date, which currently has 100,000 people enrolled, 50% of which are from underrepresented populations.

The report concluded based on the data that policy makers and other stakeholders must take action to eliminating cancer disparities by expanding access to equitable, affordable quality health care, building a more diverse science, technology, engineering, mathematics, and medicine (STEMM) trainee pipeline, and enacting comprehensive legislation to eliminate racial and ethnic health inequities, specifically the Health Equity and Accountability Act (HEAA) introduced on behalf of the Congressional Tri-Caucus, comprised of the Congressional Black Caucus, Congressional Asian Pacific American Caucus, and the Congressional Hispanic Caucus.

“We are very proud to release this second edition of the AACR Cancer Disparities Progress Report, a cornerstone of the AACR’s educational and advocacy efforts to address this important issue,” said Margaret Foti, PhD, MD, chief executive officer of the AACR, in the press release. “Cancer health disparities are a complex and multifaceted problem that will require a multidisciplinary and collaborative approach, as well as robust, sustained, and predictable federal funding for innovative research. The AACR is committed to working with all stakeholders to achieve the bold vision of health equity for all.”

REFERENCE

AACR Cancer Disparities Progress Report 2022. American Association for Cancer Research. June 8, 2022. Accessed June 15, 2022. http://www.CancerDisparitiesProgressReport.org/