Cancer questions: Studies shows race is a factor in cancer deaths

Published: 4/2/2018 10:52:50 AM

Three decades ago the federal government issued a report on health disparities and the need for change in dealing with a widening racial gap. While some advances have been made in closing that gap, there is still much to be done, especially when looking at the latest cancer statistics.

A recent study shows significant differences in survival rates over a five-year period between blacks and whites for nine of the 10 leading cancers studied in the country; lower survival rates for black women compared to white women with breast, cervical or ovarian cancers, as well as lower survival rates among black men with prostate cancer compared to white men with the disease, and lower survival rates for blacks compared to whites for a number of other cancers including colon, rectal and lung.

The study covered the years 2001 to 2003 and 2004 to 2009, and draws on the 2005 world wide CONCORD2 cancer study of survival statistics for a number of cancers from 67 countries, updated in 2015.

Survival can be altered by a number of factors, such as early detection. A cancer found earlier, but whose course is not altered by treatment, does not change the most robust measurement: cancer mortality. And while we all believe in early detection, most screenings are only modestly effective in reducing mortality, with prevention of disease and better treatment being, in general, more effective.

The American Cancer Society’s “Cancer Facts & Figures 2018” does demonstrate higher incidence and mortality rates for selected cancers for black men in comparison to white men for the more recent 2010-2015 period. These include for cancers of the colon and rectum, liver and intrahepatic bile duct, lung and bronchus, prostate and stomach. They also report higher incidence rates for black women, in comparison to white, for cancers of the colon, liver, stomach and uterus. Black women, in comparison to white, are shown as having a higher rate of mortality for cancers of the breast, colon, liver, stomach and uterus.

There has been a consistent association between lower socioeconomic status with higher death rates from cancer. Also, people living at or below the federal poverty level may be diagnosed at a more advanced stage of cancer due to lack of access to optimal medical care, adequate insurance or even exposure to education about the need for preventive screening and timely, modern cancer care. As a worrisome example, patients in a recent California study published by investigators at the University of California Davis found that cancer patients insured by Medicaid — Medi-Cal in this case — also faired more poorly in cancer mortality, as well as access to appropriate treatments, and not differently than patients who are uninsured, leading one editorialist to declare that Medi-Cal is ineffective in cancer care delivery. A bit strong, perhaps, but point made.

Connecting patients with appropriate caregivers is an issue, but the quality of care also leaves a great deal to be desired. More Medi-Cal patients were diagnosed with advanced, incurable common cancers, and fewer received appropriate, accepted treatments, than did patients with any other kind of healthcare insurance coverage. And, this despite rapidly increasing costs — up 73 percent since 2013.

Certain types of cancers are more frequent among different racial and ethnic minorities and in lower socioeconomic groupings, in part because of lifestyle behaviors associated with smoking, alcohol, poor diets high in saturated fats and possibly exposure to carcinogenic toxins. This latter factor is particularly true those who work in industries with higher risks, such as mining and petrochemical firms.

Finally, there are racial and ethnic differences in the characteristics of specific cancers. For example, breast cancers in African-American women tend to have more aggressive characteristics.

There is a clear need to address these disparities. It remains uncertain as to how cancer risk behaviors can be more effectively modified, and research into novel educational approaches will certainly be needed. However, this nation’s healthcare system must embrace the responsibility to reduce dramatically the variation in care that is repeatedly demonstrated in patient studies and to deliver proven care recommendations more consistently for best results at acceptable costs, regardless of patient background.

Dr. Wilson C. Mertens is vice president, medical director cancer services, Baystate Regional Cancer Program. He is one thel Baystate health professionals who address issues related to cancer in this space on a rotating basis each month.

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