Money, marketing and inclusion needed to ‘eradicate that gap’ in health care disparities
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Key takeaways:
- Increased public research funding necessary to bridge disparities gaps.
- Improving inclusion will make other populations feel more comfortable, benefit use of AI.
Robert A. Winn, MD, FAACR, first called for celebration.
In a roundtable discussion of the AACR Cancer Disparities Progress Report 2024, Winn spoke of the progress that has been made in cancer care overall, and in reducing disparities between different populations in the U.S.
Nevertheless, he quickly pointed out that inequities still exist and must be addressed.
“We have more room to go. There’s still a gap,” Winn, director of VCU Massey Comprehensive Cancer Center and chair of the AACR Cancer Disparities Progress Report 2024, said. “We should celebrate that it’s less of a gap, but we should also recognize and work even more in doubling down and eradicating that gap altogether.”
Over the next hour, Winn, fellow members of the report’s steering committee, and patient advocates highlighted ways the health care community could build on that progress, including the need for funding, improved communication among certain stakeholders and how inclusion could impact various inequities.
“This report really is bringing about a new convergence of a type of science in which we’re understanding it’s not just the biology, it’s how the DNA fits in with the ZNA — the zip code, neighborhood and association you live in,” Winn said.
Disparities Report 2024
As Healio previously reported, the disparities report had positives and negatives.
In 1990, Black individuals had a 33% higher risk for death from cancer than white individuals. That elevated risk declined to 11.3% by 2020. Disparities lowered in colorectal, lung, prostate and cervical cancer.
However, between 2016 and 2020, Black individuals had at least twice the risk for dying of multiple myeloma, stomach cancer or prostate cancer as white individuals.
Additionally, Black women had more than twice the risk for developing triple-negative breast cancer and a 30% higher mortality risk compared with white women. Black women also had a 40% higher risk for death from any breast cancer.
The report points out areas of improvement and continued disparities for other racial and ethnic groups as well, including increased lung cancer incidence for Asian women who have never smoked, and how history — such as red-lined districts — also contributed to inequities. It points out issues the LGBTQ+ community faces as well.
“This report, I think, is both encouraging and enlightening in the context of what we do next,” Winn said.
Funding critical
Winn and colleagues called on Congress to appropriate at least $51.3 billion to the NIH and $7.9 billion to the NCI for the 2025 fiscal year, as well as $472.4 million to the CDC.
“Saving lives is a return on investment,” Matthew B. Schabath, PhD, associate member in the departments of cancer epidemiology and thoracic oncology at Moffitt Cancer Center, said in response to a question about how funding could affect the deficit.
Winn elaborated how the medical community needs to do a better job explaining the value funding could provide.
He discussed how, decades ago, screening for lung cancer did not exist, and clinicians could only prescribe cisplatin as potential treatment.
“Some of us have been there and have seen the 170,000 lives lost to [lung] cancer drop down to 120,000,” Winn said.
“How did we get to lung cancer screening?” Schabath followed. “The NCI funded the largest randomized clinical trial in the history of mankind — 55,000 individuals randomized to chest X-ray or low-dose CT. This was huge, across 33 different sites in the U.S.,” he added. “This was not a trivial amount of money put aside to do this, and it got us to where we’re at. Early detection is reality — it’s saving lives.”
Katherine Tossas, PhD, assistant professor of health behavior and policy at Virginia Commonwealth University, and director of catchment area data access and alignment at VCU Massey Comprehensive Cancer Center, furthered the discussion using the NCI’s investment in the “Last Mile” Initiative, which supports access to self-swabs for cervical cancer screening.
“In my lifetime, I have seen it go from a cancer that almost took my mom when I was 9 years old to the only cancer that is considered irradicable,” she said.
Schabath highlighted the need for funding to research the increasing number of nonsmokers developing lung cancer. He said biology, secondhand smoke and environment can all play a factor, and unless studies are conducted, this population will continue to grow.
“The science does not just drop from the sky,” Winn concluded. “There are no Martians bringing it.”
‘Invest in messaging’
Bridging disparities involves getting the word out in as many ways possible.
That includes with government officials, which Schabath said Moffitt does multiple times a year, presenting stats and data without partisan spin.
Katrece Nolen, a breast cancer survivor, stressed the need to market information in new ways, such as social media, to raise awareness.
“We know that [individuals] like TikTok, they like Snapchat, they like Facebook and other platforms, but if you present to them messaging that is boring, that is academic, they’re not going to listen,” she said.
“We have to use tools like marketing and actually invest in marketing — invest in messaging. That’s so important,” she added. “The science is there. We’re having a hard time connecting individuals that can actually use the science to the science.”
‘We need all of our input’
Disparities and inequities will continue to persist unless more voices and more diverse data are included.
Daniel West, a gay lung cancer survivor, discussed how valuable it would have been to him had he seen a friendly face during his care or messaging that supported LGBTQ+.
He said he felt leery marking forms about his sexual identity — unsure how that information could be used. More patient advocates could have helped, he said.
The roundtable participants also discussed how inclusion will be critical with emerging technologies as well.
As AI use continues to expand, it will not benefit all populations unless data sets include everyone. It is also essential that the individuals conducting investigations and asking questions have diverse backgrounds.
“We can’t stop [emerging technologies], so we really need to join it and we all need to be more aware of how we need all of our input, not some of the input,” Tossas said.
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