Disparities in Cancer Diagnosis, Care and Outcome Are a Focus at The James

Center for Cancer Health Equity

National Minority Cancer Awareness Week was created by an act of Congress in 1987 for a simple and important reason: “While cancer affects men and women of every age, race, ethnic background and economic class, the disease has a disproportionately severe impact on minorities and the economically disadvantaged,” according to the Congressional record.

This was true then — and is still true almost 30 years later. This year, National Minority Cancer Awareness Week is April 10-16.

“Minorities are the ones who seem to be disproportionately affected with the highest incidence and highest mortality rates,” said Darrell Gray, II, MD, MPH, a gastroenterologist at The Ohio State University Wexner Medical Center and co-director of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute’s (OSUCCC – James) Center for Cancer Health Equity.

He was speaking specifically about colorectal cancer, but this situation exists for many types of cancer.

“Those same people, the minorities, those African Americans, Hispanics and those of low socioeconomic status are also the least likely to come in for screening,” Dr. Gray said, adding it’s imperative to change this dynamic in order to save lives.

Thus, the number of cancer deaths is highest in African American men, according to the National Cancer Institute (NCI), and lowest in Asian/Pacific Islander women. Colorectal cancer, as an example of this, has a higher mortality rate for African Americans than any other race.

Hispanics have a lower rate of some of the more frequently diagnosed forms of cancer, such as lung, colorectal, breast and prostate, but have higher rates than some other races when it comes to liver, stomach and cervical cancer, according to the NCI.

“You can imagine that a child born into a neighborhood without a nearby grocery store, but littered with fast food restaurants and liquor stores, lacking safe playgrounds, having under-resourced schools, and poor housing conditions might have poorer health outcomes than a child born in more favorable conditions,” Dr. Gray said.

Racial and ethnic minorities also often receive lower-quality care, Dr. Gray said, adding research studies have found “that some providers don’t give adequate care to certain groups because of stigmas and biases.”

Higher cancer rates are not exclusive to poor, urban areas and minority groups.

People in Appalachia, which stretches from southern New York to northern Alabama, Mississippi and Georgia, have higher rates of lung, cervical and colorectal cancer, said Dr. Electra Paskett, PhD, Associate Director for Population Sciences at the OSUCCC – James.

Paskett also co-directs the Center for Cancer Health Equity (CCHE) at the OSUCCC – James. The CCHE is dedicated to increasing cancer awareness in the community, focusing specifically on increasing participation in cancer clinical trials — especially by minority participants.

Goals of the program include educating the community about cancer prevention, detection and treatment and increasing minority enrollment in clinical trials and research studies, which is crucial to addressing disparities in cancer diagnosis, treatment and outcome.

Paskett leads a study researching why rates of cervical cancer are high in Appalachian Ohio. In this poorer region, certain types of cancers, also including lung and colon cancer, are more common for a number of factors. Ohio Appalachia, for example, has a 31 percent rate of tobacco use, compared to the national average of 18 percent.

A Pelotonia grant also helps fund the Cancer Disparities Research Network, in which Ohio State works with Tufts Medical Center, Fox Chase Cancer Center and the University of Illinois – Chicago, to enroll, survey and collect biospecimens from 400 people to determine if certain behaviors – such as smoking, diet, lack of exercise and lack of screenings – lead to higher rates of cancer.

Pelotonia is a grassroots bicycle tour that funds cancer research at the OSUCCC – James. To date, Pelotonia has raised more than $107 million, and is in its eighth year. One hundred percent of all dollars raised by Pelotonia directly fund cancer research.

Another program aided by Pelotonia funding, the Population Sciences’ Walk by Faith program, is a health-intervention program designed to help people eat better and lose weight. “In Appalachia, the churches are prominent, so we teamed with 30-plus churches in Appalachian areas in Ohio, Virginia, West Virginia, Kentucky and Pennsylvania,” Paskett said.

Allotting a week to minority cancer awareness is intended to raise awareness and educate minorities and other at-risk populations, with the hope that this will lead to behavioral changes and more screenings and vaccinations.

Ohio State works with these populations to educate and screen those who might be at risk. Gastroenterologists recently held a series of four colonoscopy screenings at Ohio State’s University Hospital and University Hospital East, with priority given to uninsured patients.

In some cases, vaccinations can reduce cancer rates — an example being the Human Papillomavirus (HPV) vaccination. Unfortunately, HPV vaccination is not nearly as widespread as Paskett would like it to be, and increasing the rate would “eradicate a lot of cancers, reduce the cost of treatment and increase the quality of life,” she said.

It is important for all families, and especially minorities and other at-risk populations, to be aware of the risk factors for cancer and their family histories, Dr. Gray said. These discussions will then hopefully lead to changes in lifestyle and diet and more screenings, which in turn will reduce the risk of cancer and save lives.