Cancer Disparities Conference Sheds Light on How Cancer Affects Minorities
Darrell Gray, MD, MPH, started the recent 3rd Annual Cancer Disparities Conference at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James) with an earnest request for the attendees.
“My hope is everyone will take the practical strategies they learned here back to their communities and clinics and hospitals,” said Dr. Gray, a gastroenterologist at The Ohio State University Wexner Medical Center and Deputy Director of the OSUCCC – James’ Center for Cancer Health Equity. Dr. Gray also hosted the conference.
The theme of the conference was Closing the Gap: From the Bench to the Bedside and Beyond. Dr. Gray, the speakers, and approximately 70 attendees (healthcare professionals from Columbus and beyond) shared a passion for helping minorities and lower income patients receive quality healthcare.
“Cancer care is not even across the board,” Dr. Gray said in his opening remarks. There are many reasons for this, he said, which he and the other speakers discussed, along with some possible solutions and examples of outreach programs that work. For example, the OSUCCC – James offered Screening Saturdays in March (Colorectal Cancer Awareness Month), during which free colonoscopies were performed at Ohio State’s University Hospital East and University Hospital. Priority was given to uninsured patients.
“This (conference) is a unique event and Darrell and his colleagues (at the OSUCCC – James) are really leading the way in raising awareness about cancer disparities and doing something about it,” said Samir Gupta, MD, MSCS, Associate Professor at the University of California – San Diego’s Moores Cancer Center.
The incidence of cancer and the death rate is higher among minority groups, especially African-Americans, said Dr. Gupta, the conference’s keynote speaker. For example, he said “the incidence and mortality for gastric cancer are far higher for minority populations than (they are for) non-Hispanic whites” and “pancreatic cancer incidence and mortality are higher for blacks compared to other groups.” African-Americans have the highest incidence and mortality rate for colorectal cancer.
There are many reasons, Dr. Gupta said, adding not enough studies have been conducted to fully understand the role of genetics. What is known is that the lack of access to care, education levels and environmental factors such as access to healthy food, cultural fears, as well as increased rates of smoking and obesity are all factors for higher cancer rates and seem to inversely impact minority populations.
“First and foremost, do people have insurance?” Dr. Gupta said. “Do they have a ticket to see a doctor and proximity to screenings and treatment providers?” The Affordable Care Act (ACA), he said, provides such a “ticket” to millions and its repeal “could increase cancer disparities.”
Place matters too, said Electra Paskett, PhD, Associate Director for Population Sciences and Director of the Center for Cancer Health Equity at the OSUCCC – James.
For example, she said there are “hot spots” for colorectal cancer, including Appalachia, a cultural region that stretches from southern New York to northern Alabama and Mississippi. The toxins, chemicals and exposure to sun in some areas are higher than in others and can lead to more cancer cases.
States that grow tobacco tend to have lower cigarette taxes, which in turn leads to more smokers and more cancer, Dr. Paskett said. “Many people live in areas where there are more places to buy cigarettes than there are to buy fresh fruit and vegetables.”
In several areas of Appalachia, there are no mammogram facilities. “There was one Ohio county in Appalachia where 48 women were detected with abnormal pap smears and no provider in the county would see them because they didn’t have insurance,” Dr. Paskett said. The OSUCCC – James teamed with local county health departments to make follow-up tests possible and provided patient navigators to make sure women made and went to their appointments. The OSUCCC – James mobile mammography unit also travels to Appalachia on a regular basis.
“All the gains we’ve made in increasing the percentage of mammograms because of the Affordable Care Act could all go away (if it ends up being repealed),” Dr. Paskett said.
Minorities are also underrepresented in clinical trials, said Paul Monk, MD, Associate Professor, Division of Medical Oncology at the OSUCCC – James. “Minority physicians have a higher rate of enrolling minority patients,” he said.
Heather Hampel, MS, LGC, Associate Director of the Division of Human Genetics at the OSUCCC – James said overcoming a lack of education about the benefits of screenings and genetic testing, combined with a fear of cancer is a big hurdle for many people.
“If I can get them into my office and explain the risks they face (without genetic testing when it is indicated), they’re just as likely as non-minority patients to undergo genetic testing,” she said. “The hurdle is getting them there.”
Another underserved population is the LGBTQ community, said Julia Applegate, MA, Director of the Institute for LGBTQ Health Equity at Equitas Health.
“We can’t identify healthcare providers who we feel safe with,” she said, adding “there’s a fear of being stigmatized by our providers” and a higher percentage of LGBTQ people without insurance. “It’s much better than it was 25 years ago, but not everything is fixed and the climate is starting to get scarier.”
A patient’s religion can also be a barrier.
“You need an understanding of the different religions of patients and know how to talk with them and be sensitive to their concerns based on their religion,” said Mary Lynn Dell, MD, DMin, Director of Psychosomatic Medicine at Nationwide Children’s Hospital and The Ohio State University.
Dr. Gray is confident the attendees will take what they learned back to their communities, clinics and words and become advocates for change and increased access. “We’re creating the champions who will close the gap in disparities,” he said.
To reduce your risk of cancer, it’s important to know your family history, get screened when appropriate and know your risk. More information on cancer risk factors and prevention tips are available from the National Cancer Institute.
Learn more about what our Center for Cancer Health Equity is doing to reduce cancer rates in the community. Additionally, our Genetic Counseling program provides leading-edge cancer risk assessments in a caring, supportive environment.