Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: April 14, 2006
In 2006, it is expected that just under 1.4 million people will be diagnosed with cancer, and over one-half million people will die from the disease. Cancer is the second leading cause of death for both white Americans and African-Americans, but if you take a closer look, things are not quite so equal. Researchers are finding significant disparities in rates of diagnosis and death. For instance, although African-American women are less likely to develop breast cancer than are white women, they are actually more likely to die from it. Similarly, twice as many African-American men die from prostate cancer than do white men. Other minority groups are not spared these statistics; for example, Hispanic women are more likely to be diagnosed with cervical cancer. While American Indian and Alaskan Natives experience some of the lowest rates of cancer among all groups, they do experience higher death and incidence rates for certain cancers.
April 16-22nd is Minority Cancer Awareness Week, and is an effort to bring much needed public attention to this issue.
OncoLink sat down with Dr. Chanita Hughes Halbert, Assistant Professor of Psychiatry and Director of the Community Cancer Prevention and Control Initiative at the Abramson Cancer Center, to talk about the issues facing minorities in cancer care today.
: Dr. Hughes, thank you for taking time to talk with us today. I have been reading that African-Americans, by some estimates, have a 10% higher incidence of cancer diagnoses than other races. This is a considerable increase, and yet I don't hear much about this in the popular media. Is this estimate too high, or is this problem not getting the attention it should?
Dr. Hughes- Halbert: Overall, the rates of cancer incidence (number of cases) and mortality (number of deaths) are higher among African-Americans. For example, the American Cancer Society estimates that the incidence of cancer is about 20% higher in African-American men relative to white men. In terms of deaths, death rates for all forms of cancer are highest among African-Americans. I think it is important to note, however, that while the cancer incidence and death rates continue to be higher among African-Americans compared to individuals from other ethnic and racial groups, the overall five-year cancer survival rate (percent of patients alive 5 years after their diagnoses) has improved in this population, from about 27% during 1960-1963 to 55% in 1995-2001.
: Minorities are less likely to receive cancer screening and are more often diagnosed at a later stage in the disease. Is this disparity fully explained by a lack of access to healthcare?
Dr. Hughes- Halbert: There are a number of factors that contribute to disparities in cancer [care]. Lack of access to healthcare plays a large role [in determining] the stage of disease at diagnosis. Screening can detect cancer in earlier stages, when treatment is most likely to be successful, yet patients without healthcare access are unlikely to undergo screening. However, other factors may contribute to [under]-utilization of cancer screening, and ultimately [to the] stage of disease at diagnosis. These factors may include the presence of other health problems and lower quality healthcare. I think it is important to realize that access to care is really an extremely complex set of interrelated factors that can be influenced by someone's beliefs and values about healthcare, in addition to physician recommendations, adequate insurance coverage to pay for screening tests, and sufficient access to facilities where screening tests are performed.
: African-Americans, in particular, are more likely to die from their cancer diagnosis, leading researchers to believe that their cancers are somehow different. Does this mean a prostate cancer in an African-American man is biologically different than in a white man? And does this mean it should be treated differently?
Dr. Hughes- Halbert: At the most basic level, cancer is defined as an "excessive growth and spread of abnormal cells" (American Cancer Society, Cancer Facts and Figures for African Americans, 2006, p. 2). Differences in tumors between African-Americans and whites have been identified for some types of cancer, and these differences may have implications for treatment. For example, studies have shown that African-American women are more likely than white women to be diagnosed with estrogen receptor-negative breast tumors. However, more research needs to be done in this area [in order] to understand these differences and what they may mean for treatment. One project in the Penn Center for Population Health and Health Disparities, led by Timothy Rebbeck, Ph.D., is designed to understand racial differences in prostate cancer by characterizing the natural history of prostate cancer among African-American and white men and by identifying genetic factors that may explain racial differences in prostate cancer outcomes.
: Can clinical trials help find the answers to these questions?
Dr. Hughes- Halbert: Clinical trials play an important role in helping to understand differences in cancer risk factors, tumor biology, and treatment outcomes between African-Americans and individuals from other ethnic and racial groups. Clinical trials testing the effects of interventions designed to improve behavioral and psychological outcomes among African-Americans are also important to address cancer disparities in this population. For example, developing a culturally targeted program to help a certain culture better understand the importance of screening and their [culture-specific] risk may lead to earlier diagnoses and fewer deaths. I am running a trial looking at a culturally tailored genetic counseling program for African-American women [who are] at risk for breast cancer. However, significant challenges may be experienced [in] recruiting African-Americans to participate in clinical trials because of the study inclusion and exclusion criteria, lack of knowledge about the availability of studies, and concerns about being a study participant, or "guinea pig". Increased efforts are needed [in order] to encourage African-Americans to participate in clinical trials.
: What efforts are going on in the research and public health communities to address these disparities?
Dr. Hughes- Halbert: Over the past several years, cancer disparities in African-Americans and other underserved minority groups have received a significant amount of attention. In fact, addressing cancer disparities is now a priority for many federal, state, and local health-related agencies. In 2003, for example, the institutes and centers at the NIH funded eight different "Centers for Population Health and Health Disparities". These centers seek to identify the factors contributing to health disparities, and try to develop and evaluate interventions for reducing the differences in all health outcomes among racial and ethnic minority groups. Several of these centers focus on cancer disparities. The Penn Center for Population Health and Health Disparities, which is led by Timothy Rebbeck, Ph.D. and myself, has a specific focus on identifying causes of ethnic differences in prostate cancer outcomes. These studies are the first step to developing and implementing strategies to address these differences and improve outcomes following prostate cancer diagnosis and treatment among African-American men.