American Cancer Society CEO delivers call to action on genitourinary cancer disparities
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SAN FRANCISCO — Addressing disparities in genitourinary cancers requires more research on changing risk factors and immediate actions aimed at prevention, Karen E. Knudsen, PhD, MBA, said during ASCO Genitourinary Cancers Symposium.
Knudsen — who last year became CEO of American Cancer Society and its advocacy affiliate, American Cancer Society Cancer Action Network — used her keynote address at the symposium to highlight trends in genitourinary cancer incidence and mortality in the United States, as well as priorities for the field.
More than 3.5 million cancer deaths have been averted since 1991 following a “doubling down of investment in cancer research,” Knudsen said.
“Yet, we are not quite satisfied,” she added. “We know, as much as we celebrate that 32% reduction in cancer mortality, that advances have not benefited everyone. ... We have much work yet to do.”
Known sources of racial disparities in cancer outcomes include lack of transportation, need for housing near cancer centers, gaps in health and digital literacy, hesitation to enroll in clinical trials, and unconscious bias among providers and health systems.
“Let’s take these to be truths that we know exist and move beyond to implementation strategies,” she said.
Genitourinary cancers, which account for more than 20% of new cancer cases annually, pose a substantial problem, Knudsen said. Prostate and bladder cancer alone are responsible for 14.4% of all cancer deaths among men, she added.
Bladder cancer
Disparities in bladder cancer include four times higher incidence and three to four times higher mortality among men than women. This pattern is distinct from lung cancer profiles, which show the sexes converging, Knudsen said.
Meanwhile, mortality rates have declined steadily among Black men while remaining higher among white men, again differing from patterns in lung cancer.
“From research, we may ask ourselves in terms of risk factors, is there something that we are missing?” Knudsen said. “We also know that there is no current screening method for individuals of average risk. We’re also watching development of multicancer early detection tests, and we anxiously await firm demonstration that these tests actually show clinical benefit.”
Strategies that could be implemented immediately include enhanced tobacco cessation efforts, she said.
Kidney cancer
The long-term increase in incidence of kidney cancer — mostly localized-stage diagnoses — can be attributed in part of incidental detection of asymptomatic tumors through increased medical imaging, Knudsen said.
“There’s a slow but steady increase across gender [and] demographics, so very different than what we saw with bladder cancer,” she said. “We would suggest the call to action here, in fact, is prevention, because about half of kidney cancers that are reported now can be prevented through eliminating strong risk factors to this disease. [These] include excess body weight and tobacco smoking.”
Kidney cancer mortality, which has been declining since the mid-1990s, has remained relatively level among Black men despite their higher incidence rate, while increasing among both men and women.
Research should seek to identify the basis for the discrepancy in incidence and mortality among Black men and lower incidence among Asian/Pacific Islanders, as well as additional risk factors, Knudsen said.
She suggested promotion of healthy lifestyle and prevention strategies as immediate actions that could be taken.
Prostate cancer
Incidence of prostate cancer declined substantially following the U.S. Preventive Services Task Force recommendation against screening; however, it remains 73% higher among Black men than white men. Reasons for this difference remain unknown, Knudsen said.
Screening rates among Black men and white men in the U.S. are about equal but remarkably low, she said.
“While they may be equitable, I don’t think we can celebrate one-third of men [undergoing] prostate cancer screening,” Knudsen said.
An uptick in incidence of localized-stage and regional-stage disease occurred after readjustment of the screening guidelines, but the most dramatic shift has been observed in distant-stage disease, which has increased 4% to 6% annually since 2011.
“To us at the American Cancer Society, this is a call to arms,” Knudsen said.
Sharp declines in mortality rates across all groups since the mid-1990s are beginning to flatten, which may indicate a saturation of testing or need for new therapeutic strategies, Knudsen said.
Her calls to action included screening refinement and intensification of research for new therapeutic strategies.
A review of regional differences in prostate cancer incidence and mortality across the U.S. revealed striking variations that should be investigated, Knudsen said. For example, incidence and mortality rates appeared balanced in Florida, whereas California had the lowest incidence yet the highest mortality. In the Carolinas, Black men had significantly higher mortality rates than white men, whereas in New York and Texas, Black men and white men had equitable outcomes.
“We know part of that is access to care,” Knudsen said.
Knudsen suggested evidence-based screening uptake to reverse the shift in diagnosis to more advanced-stage disease. She also emphasized the need for efforts to address disparities in outcome by region and demographic, underuse of germline testing in localized disease and variations in clinical trials uptake.
Testicular cancer
Incidence of testicular cancer has increased for all subgroups, but Knudsen described the increase in both incidence and mortality among Hispanics as alarming.
“There’s a significant call to action here, as well, to increase screening, to increase awareness and truly understand the risk factors,” she said.
Regional variations have been identified across the nation. For example, Louisiana has balanced testicular cancer incidence and mortality rates, whereas Arizona has the lowest incidence and highest mortality.
Understanding the basis for these variations should be a research priority, Knudsen said. “But right now, we can increase awareness and we can increase screening uptake,” she said. “I will point to you, as CEO of the American Cancer Society, now that we have come to this realization, we will be part of that solution in the states that have this high incidence.”
References:
- Cancer facts & figures 2022. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf. Accessed Feb. 18, 2022.
- Knudsen KE. A path forward, a call to action: Addressing trends and disparities in genitourinary cancers. Presented at: ASCO Genitourinary Cancers Symposium; Feb. 17-19, 2022; San Francisco.
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Knudsen KE. A path forward, a call to action: Addressing trends and disparities in genitourinary cancers. Presented at: ASCO Genitourinary Cancers Symposium; Feb. 17-19, 2022; San Francisco.
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