Eliminating Cancer Health Disparities: A Moral Imperative

By Andrew von Eschenbach, MD
Director, National Cancer Institute

With the progress researchers have made toward eliminating the suffering and death caused by cancer, the disease is no longer the automatic death sentence it once was. Thanks to promising advances in cancer research and modern technology, we have hope that cancer will become a non-fatal disease for everyone.

But not all segments of the U.S. population have benefited equally from advances in prevention, early detection and treatment. The burden of cancer is too often greater for poor, ethnic minorities and the uninsured than for the general population. The unequal burden of cancer in our society is more than a priority goal of the National Cancer Institute (NCI)—it is the will of the nation.

Health disparities are significant differences in the overall rate of disease or survival rate in a specific group of people, compared to the general population. Many ethnic minorities in the United States develop cancer more frequently than the majority of the white population. African-American males, for example, develop cancer 15 percent more frequently than white males. Several specific forms of cancer affect other ethnic minority communities at rates up to several times higher than national averages.

Many of the differences in cancer incidence, mortality rates, risk factors and screening prevalence may be due to socioeconomic characteristics of populations within racial and ethnic minority groups. Cancer health disparities occur within the broad context of human circumstances, including substandard housing, poor educational opportunities, adverse environmental exposures and limited access to quality healthcare.

In order to address health disparities, we must view them through the historic and present-day lens of inequity and social injustice. Health disparities result from unfair treatment when one group of Americans receives better care than another. A 2002 report of the Institute of Medicine found that even when insurance status, income, age and severity of conditions are comparable, racial and ethnic minorities tend to receive lower-quality healthcare than whites.
A system of barriers exists that cause cancer health disparities, including the need for some patients to battle with insurers to obtain coverage for life-saving care. For some, the devastating costs of cancer care can lead to bankruptcy and loss of dignity.

Other barriers to care are physical. Living in rural areas poses special burdens that involve travel to distance care providers. Informational or educational barriers—lack of information or education, failure to comprehend English, not knowing how to find or assess information, not knowing how to get needed care within the health system—all can constitute enormous barriers to cancer care. Still, other barriers to the best cancer care can stem from cultural differences and biases. In cultures where pain is tolerated, patients may not request medication to alleviate their discomfort.

Research studies have provided evidence that equal treatment yields equal outcome across all populations. And by providing universal access to the currently tested and available interventions for the prevention, early detection and treatment for breast, cervical and colorectal cancers, we could dramatically reduce cancer mortality rates.

NCI-supported Special Population Networks (SPNs), currently at 18 institutions across the country, are building long-term relationships between research institutions and community-based programs. SPNs are learning more about the causes of cancer disparities in minority communities and developing and testing ways to address and eliminate these causes.

In addition, NCI is piloting an innovative program for placing patients in contact with “patient navigators” to help individuals and their families work with an often complex healthcare system. Patient navigators are experienced advocates who work with underserved people to help them gain access to care and provide guidance on financial assistance, among other services.

Cancer health disparities are a major public health issue. Through efforts to understand and reduce biologic, socioeconomic and cultural disparities in the incidence of cancer among diverse population groups, we can continue to make progress.