Although there has been substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades, addressing cancer health disparities—such as higher cancer death rates, less frequent use of proven screening tests, and higher rates of advanced cancer diagnoses—in certain populations is an area in which progress has not kept pace.
These disparities are frequently seen in people from low-socioeconomic groups, certain racial/ethnic populations, and those who live in geographically isolated areas.
Documented cancer health disparities include:
- a higher incidence of a particularly aggressive form of breast cancer (the triple-negative subtype) among African American women than women of other racial/ethnic groups
- substantially higher rates of prostate cancer incidence and death among African American men than men of other racial/ethnic groups
- higher rates of kidney cancer among American Indian and Alaska Natives than other racial/ethnic groups
- higher rates of liver cancer among Asian and Pacific Islanders than other racial/ethnic groups
- higher rates of cervical cancer incidence and death among Hispanic and African American women than women of other racial/ethnic groups
Many of the same population groups that experience cancer health disparities are also significantly underrepresented in cancer clinical trials.
There has been some recent evidence of progress against cancer health disparities, including reductions in lung and prostate cancer deaths among African American men over the past decade. But researchers and public health officials agree that progress has come too slowly, and the cost of disparities—in terms of premature deaths, lost productivity, and the impact on communities—remains substantial and must be addressed.
Cancer disparities and equity research is needed to understand why some groups of people may be more or less likely to develop cancer, experience cancer-related health problems, or die from cancer than other groups of people.
Opportunities in Cancer Health Disparities Research
As recognition of cancer health disparities has grown, so have efforts to move beyond simply documenting the problem toward understanding all of its causes and developing and testing interventions to remedy it. Studies suggest that the differences observed in cancer incidence and mortality between various population groups are the result of a complex interplay of genetic, environmental, and social factors.
For example, access to care is a critical element that contributes to cancer health disparities. Access to care is influenced by a web of factors, such as insurance status and proximity to health care facilities. Changes that have been implemented as a result of the Affordable Care Act are already helping to address the issue of access to health care by making recommended cancer screening and prevention interventions more affordable and expanding Medicaid.
Patient navigation, which is a strategy to help patients maneuver through our complex health care system, has also shown promise as a means of addressing cancer health disparities. Navigators can help patients overcome the multitude of barriers that can derail access to quality care, such as insufficient finances and lack of transportation.
As the issue of disparities has gained more attention in the cancer research and public health communities, it has produced more opportunities for collaboration among researchers. One such area of collaboration involves efforts to increase the diversity of participants in clinical trials, which can ensure that trial findings are applicable to a broader patient population.
The greater recognition of cancer health disparities is also prompting researchers to test community-level interventions that address the unique needs of specific populations in which disparities are particularly problematic, such as Native American and Appalachian populations.
Moreover, as researchers fine tune their understanding of the underlying biology of cancer, they are learning more about the biological differences that may contribute to cancer health disparities, potentially producing more tailored approaches to prevention, diagnosis, and treatment.
Challenges in Research to Reduce Cancer Health Disparities
Developing ways to improve access to quality cancer care—from access to smoking cessation programs and recommended cancer screenings to timely treatment—continues to be one of the most daunting challenges facing the cancer research community.
Access to care is affected by many socioeconomic and policy-level factors that are beyond the control of the research and public health communities. Some of these factors include lack of access to health care facilities, state and federal policies on health insurance, and hospital and physician payment rules.
Beyond access, it can be difficult to tease apart the complex mix of factors that may contribute to differences in disease outcomes among different racial/ethnic groups—including environmental (e.g., exposure to secondhand smoke), behavioral (e.g., higher rates of alcohol use and physical inactivity), cultural (e.g., mistrust of the health care system and fatalistic attitudes about cancer), and biological factors.
Researchers are working hard to overcome these hurdles and to design and test interventions that can address the various drivers of disparities in different population groups.
National Cancer Institute