Recently in Health Disparities Category

By Deborah Thomas, Staff Writer

The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.




Deborah Scott, of the Native American Health Care Coalition, says, "In the native community breast cancer is a big problem, because many women are diagnosed late." According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American Indian/Alaska Native women have the lowest incidence of breast cancer yet have the poorest five-year survival rates.

Event Sponsors:
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition
M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of... Wellness

African-Americans die of cancer at much higher rates than any other racial or ethnic group in the United States. Cancer's toll on African-Americans is particularly high for cancers of the lung, colon and rectum, female breast, prostate and cervix.

The American Cancer Society estimates that about 152,900 new cancer cases will be diagnosed and 62,780 cancer deaths will occur among African-Americans annually. In Texas, African-Americans' cancer mortality rates are 38% higher for men and 22% higher for women, compared to non-Hispanic Whites.

The reasons behind African-Americans' higher rates of cancer occurrence and death are still largely unknown. Large cancer prevention studies, which can help identify specific risks for different populations, often have very low participation from minority communities. This limits the ability of researchers to understand whether the risks that are found for the entire population are the same for specific groups, such as African-Americans.

To reduce the burden of cancer in the African-American community, researchers and the community need to join forces to conduct focused research and to promote activities that will reduce cancer risks. Effective cancer prevention activities for African-Americans need to take into account not just their social situation and the environment they live in, but also their life priorities and concerns.

The African-American Cancer Prevention Project (AACPP) is a collaborative study between the Department of Health Disparities Research and Windsor Village United Methodist Church in Houston, home to the largest African-American Methodist congregation in the United States. This type of study, known as a cohort study, follows healthy individuals over time to see how behavioral, social and environmental factors (such as weight management, cigarette smoking, cancer screening, health care, work and financial issues, neighborhood environment and mental health), contribute to cancer risk for African-Americans.

To date, 1,500 individuals have been enrolled in the study and they will be followed for three years, receiving periodic health assessments, as well as programs and services designed to address concerns such as stress, smoking, and exercise and fitness. Participants also receive help to navigate health and cancer screening and treatment services.  

Open and continuous communications, a lengthy history of community support and the full backing of church leaders have enabled the study to successfully reach its recruiting goals on time. Information gathered from the study will help to increase our understanding and ability to assess cancer risks in African-Americans, as well as identify areas that both M. D. Anderson and the community can focus on to reduce the burden of cancer for African-Americans.

Other Resources
Minorities and Health Disparities (CDC)

African American Health (MedlinePlus)

By Bayan Raji, Staff Writer

Cancer among elderly people and minority groups is expected to increase dramatically over the next 30 years, precipitating a need for increased research in two groups that often are under-represented in clinical trials.

The study by researchers at M. D. Anderson, published in the June issue of Journal of Clinical Oncology, predicts cancer diagnoses over the next 30 years.

Population, cancer cases will grow

To conduct their research, the team looked at U.S. Census Bureau statistics, updated in 2008 to project population growth through 2050, and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database.

They found:
•    The U.S. population is expected to grow from 305 million in 2010 to 365 million in 2030
•    The total number of cancer diagnoses per year will increase from 1.6 million in 2010 to 2.3 million in 2030
•    In 2030, 70% of cancers will be diagnosed in the elderly
•    In 2030, 28% of cancers will be diagnosed in minorities

The study highlighted three important issues:
•    Clinical trial participation
•    Increasing cost of cancer care
•    Expected shortage of oncologists

Groups face challenges

From 2010 to 2030, the rate of cancer is predicted to increase:

•    65% in elderly people
•    100% percent in non-white people

These groups are under-represented in clinical studies and are vulnerable to sub-optimal cancer treatment.

"The fact that these two groups have been under-represented in clinical research participation, combined with the groups' rapid growth in cancer diagnoses, reflects the need for clinical trials of new therapies to be more inclusive and to address issues that are relevant to both populations," says Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology and the study's senior author.

Screening, prevention crucial

Cancer rates will increase by:

•    31% in whites
•    64% in blacks
•    76% in American Indian-Alaska Natives
•    101% in multi-racial people
•    132% in Asian-Pacific Islanders
•    142% in Hispanics

Screening and prevention will become essential tools to help prevent a similar growth in cancer deaths. However, no easy answer exists, according to Smith.
"There's no doubt the increasing incidence of cancer is a very important societal issue," Smith says. "There will not be one solution to this problem, but many different issues that must be addressed to prepare for these changes."
Changes take toll on system

The cost of cancer care continues to grow at a rate that's not sustainable for patients.

"As we design clinical trials, we need to seek not only the treatment that will prolong survival, but prolong survival at a reasonable cost to patients," Smith says. "These are two issues that oncologists need to be much more concerned about and attuned to."

A shortage of medical oncologists will have an impact on the health care system by 2020, according to the American Society for Clinical Oncology (ASCO).  

Smith says ASCO and other professional medical organizations beyond oncology are aware of the problem and are trying to increase the number of physicians, nurse practitioners and physician assistants.

More research needed

Unless specific prevention and treatment strategies are discovered, cancer death rates will increase dramatically, according to Smith.

"It's alarming that a number of the types of cancers expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates," he says.

M. D. Anderson resources

Audio Interview with Dr. Smith about Cancer Rate Growth (Cancer Newsline)

Cancer Incidence Rates Among Minorities Expected to Increase (David Wetter, Ph.D)

Division of Radiation Oncology


Other resources

Cancer Health Disparities (National Cancer Institute)

How do you discuss a topic that most people hope they never have to think about, and that is about as appealing as a fuzzy brown Chinese gooseberry or a bug-eyed Patagonian toothfish? Like the wildly successful re-marketing of the popular Kiwi fruit (formerly Chinese gooseberry) and the Chilean sea bass (formerly Patagonian toothfish), the key to talking about cancer clinical trials is framing the issue in ways that are relevant and meaningful to the audience.  
                        
In Texas, 70% of cancer patients are white, even though the white population makes up only 48% of the population of Texas. Hispanics make up 37% of the population, but only 17% of new cancer cases. This surprising statistic is largely due to the fact that while minorities experience higher cancer rates in general, there are fewer minorities currently diagnosed with cancer. Minorities as a group -- in particular Hispanics -- are younger than the white population, and age is a significant risk factor for cancer. The older you are, the more your risk for cancer increases. In Texas, 70% of people older than 70 are white.
To reach healthier, younger people -- in particular Asians and Latinos -- we talk about cancer preparedness as a tool to maintain and protect their health and that of their families.

Residents of the Texas Gulf Coast are very familiar with the concept of hurricane preparedness. Every hurricane season, meteorologists are the most visible people on TV, as they share the latest news about potential hurricanes forming, and communicate messages of awareness, preparation and appropriate action. The annual rituals of stocking batteries and canned foods, filling the tub with water and the tank with gas become matter-of-fact behaviors, and not reasons for fear or distress. Certainly we hope that the hurricane does not head our way, but if it does, we will know what to do and how to do it.

Cancer preparedness takes the same approach. Health education specialists in the Minority & Women Clinical Trials Recruitment Program promote cancer awareness, prevention and screening with Hispanic and Asian audiences. They provide information about treatment options, including clinical trials, as resources that audiences can use to help themselves, their parents and elders decide the most appropriate course of action, for optimal survival and outcome, should the hurricane of cancer enter their lives. 
 

New research by Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology, has proven true Yogi Berra's assertion that, "The future ain't what it used to be!"

Taking into account who's growing old in the United States and how many of us will be old by 2030, Smith projects a 45% increase in cancer diagnosis in general and a 99% increase in cancer incidence among minorities (compared with a 31% increase for non-minorities).

It's very important to note that the researchers aren't saying that anyone's risk for cancer will increase. In fact, their estimates hold the risk to be exactly the same as it is today. Rather, what they're saying is that the number of cancer cases will increase simply because the U.S. population is aging (and older people are more likely to get cancer), and because the proportion of minorities in the U.S. is increasing (so they will make up a bigger percent of the cancer cases in 2030 than they do now).

Among minority groups, expected increases in cancer incidence are:

• 64% for African-Americans
• 76% for American Indian/Alaska natives
• 132% for Asian/Pacific Islanders
• 142% for Hispanics

Currently, although minorities often have higher risk for some cancers, the actual number of minorities who have cancer is low because minorities as a group are younger than the white population and younger people are less likely to get cancer. However, the large group of middle-aged minorities today will make up the group of "old" people in the year 2030. At that time, minority populations will experience the double burden of higher cancer risk and older age. The result will look like an epidemic of cancer in this population. 

Why is this information important for researchers like me and dedicated, caring folks like you? Having a glimpse of the future means that we have time to put into place actions today that can significantly impact the rate of cancer, as well as deaths from cancer, for specific population groups. For example, because minorities are more affected by cancers of infectious origins such as liver cancer and cervical cancer, by implementing effective prevention, education and screening strategies today, we may be able to limit the cancer burden in this group in 2030.

Smith suggests vaccination programs for hepatitis B and human papilloma virus, chemoprevention with tamoxifen and raloxifene, social interventions such as tobacco and alcohol cessation that work for minority groups, and removing pre-cancerous polyps in the colon.

Finally, increasing minorities' participation in cancer clinical trials today will reap even more benefits for care in the future. It will help us to better understand the impact of race on how tissues respond to cancer treatment, the biology of cancer in different groups and effectiveness of cancer therapy for these groups.

One of the fun things about being a clinical psychologist is that when I tell strangers my profession, they typically have one of two reactions: they start backing away under the belief that I can read their minds or they immediately start telling me all sorts of personal information that they'll later regret sharing.

On top of that, I usually get a very puzzled look when I tell them that while I truly can read their minds (just kidding), my work involves studying cancer health disparities. And that almost always requires a definition of health disparities, a description of the causes, who it affects and strategies for reducing it.

So, here's the 30-second overview.
 
Health disparities refer to differences in health status and health outcomes among different groups. These differences can result from genetics, environmental factors, access to care and cultural factors. For example:

• Hispanic women have almost twice the rate for cancer of the cervix as non-Hispanic white women
  
  
• Asian men have the highest rate of liver cancer of any racial/ethnic group and three times higher than that of non-Hispanic white men
  
  
• African-Americans have the highest cancer incidence and mortality rates overall compared to any other racial/ethnic group

It's important to note that health disparities affect more than just racial/ethnic minorities. Other groups that experience health disparities include the poor, rural residents, individuals with low literacy and many other groups.
 
Our goal in the Department of Health Disparities Research is to reduce and ultimately eliminate disparities in cancer incidence, morbidity and mortality through research and education. Some examples of our research include:

• How to help low-income pregnant women who smoke quit and stay that way
• How to reduce barriers to participating on a breast cancer trial for minority women
• How migrant farm workers' exposure to pesticides affects not only their genes and risks for cancers, but their children's genes and risks as well 

Of course, no research would be possible without people willing to participate in research. Our programs partner with community organizations to increase awareness and understanding among underserved populations of the role of research and clinical trials in cancer prevention and treatment.
 
Fortunately, our work is attracting more and more interest. We're hoping that we get to the point, as quickly as possible, where I don't have to do any introduction to the topic of health disparities, except as a history lesson.