Cancer is the second leading cause of death in the United States. One deadly aspect of managing the disease that has been around for quite some time — but has garnered more attention in recent years — is the range of disparities that exist when it comes to cancer screening, diagnosis, care, and many other factors.
What does "disparities" mean? When it comes to cancer, it means that even though anyone can get the disease, some groups of people in the United States are disproportionately impacted by cancer as a result of social, environmental, and economic disadvantages, says the National Cancer Institute, noting examples such as:
- Black and African Americans experience higher rates of death for many types of cancer.
- In the Appalachian region of the United States, rural areas have higher incidence rates of lung, colorectal, and cervical cancers than urban areas.
- Hispanic or Latina women and Black or African American women experience higher rates of cervical cancer than women in any other racial or ethnic group.
In recognition of World Cancer Day, Everyday Health brought members of the cancer community together to discuss the disparities in cancer rates, diagnosis, care, and more. Using the Twitter hashtag #LetsTalkCancerDisparities, advocacy organizations, experts, and other members of the cancer community touched on topics including why disparities exist, why they’ve only recently gained more widespread attention, how COVID-19 has affected cancer-related disparities, and additional resources with information about disparities and how to cope with them.
The chat featured:
- Prostate Cancer Foundation A leading philanthropic organization dedicated to funding and accelerating prostate cancer research around the world (Follow @PCFnews)
- LUNGevity Foundation An organization focused on funding lung cancer research and providing support to all who are affected by lung cancer (Follow @LUNGevity)
- Cancer Support Community An organization ensuring all people affected by cancer are empowered by knowledge, strengthened by action, and sustained by community (Follow @CancerSupportHQ)
- Touch, The Black Breast Cancer Alliance An organization dedicated to eradicating breast cancer among Black women, who have a 42 percent higher rate of breast cancer death compared with white women (Follow @touchbbca)
- National LGBT Cancer Network The only cancer program in the United States founded and directed by members of the LGBT community (Follow @cancerlgbt)
- ATOPP Summit An education and networking meeting for advanced pharmacy professionals about oncology, hematology, immuno-oncology, and oncopharmacology (Follow @atoppsummit)
- NewYork-Presbyterian Hospital Based in New York, and home to @columbiamed and @weillcornell doctors
- Baptist Health South Florida A faith-based, not-for-profit healthcare organization in the South Florida area (Follow @BaptistHealthSF)
- David W. Lim, MD, PhD General surgeon and breast surgical oncologist at @WCHospital (Follow @DavidLimMD)
- Erika Stallings A writer, music industry attorney, and BRCA awareness advocate (Follow @quiddich424)
- Sean Marchese, RN Writer and registered nurse for The Mesothelioma Center (Follow @SeanMarchese)
Want to get the lowdown on the #LetsTalkCancerDisparities Twitter chat? Read on for some of the highlights.
Everyday Health: Let’s start with definitions. Disparities is a broad term. How would you define it in the context of cancer care?
Prostate Cancer Foundation: Disparity starts with a metric in one population — like diagnosis of cancer — and compares it with another population. For example, Black men are over 75 percent more likely to be diagnosed with and over 2 times more likely to die from #prostatecancer.
National LGBT Cancer Network: Cancer disparities are caused by societal inequities and injustices. Contrary to popular belief, cancer does not treat everyone equally.
Stress, discrimination, barriers to healthcare, criminalization, social isolation, bereavement, racism, homophobia, transphobia, anti-immigrant sentiments, and fear of being mistreated by doctors all contribute to later diagnosis and worse outcomes.
RELATED: Closing the Gap in Breast Cancer Care and Support for Black Women
EH: Cancer disparities have become a hot button issue in the last few years, but it is an issue that has been around for some time. Why do you think it’s now starting to gain attention?
ATOPP Summit: We are becoming more aware of the impact of #disparities in the care of people with #cancer through channels such as mainstream media. And we are becoming more vocal and willing to talk about it.
Everyday Health: Disparities in our country in particular are about more than race. They’re also about economics and geography. What’s your experience with this?
Prostate Cancer Foundation: Gay and bisexual men and transgender women may be at risk for reduced access to #prostatecancer screening and treatment. More research is needed to identify unique needs for such patients.
Disparities impact other populations in #prostatecancer. Uninsured patients with high-risk disease are less likely to receive definitive therapy and more likely to have treatment delay. Evidence suggests rural patients are less likely to be treated.
ATOPP Summit: Approximately 90 percent of the U.S. population lives within five to six miles of a #pharmacy. But we also know that disproportionately underserved populations have fewer options and less access to a #pharmacist in the community.
And not all people with #cancer have access to a #pharmacist, despite being treated at large medical facilities. We know outcomes for everyone can improve when #pharmacists are part of a patient's medical team.
Dr. David W. Lim: Health insurance and health coverage matters are important factors in access to care. Interestingly, in Canada, despite universal healthcare coverage, we have the same disparities with socioeconomic status, geography (rural versus urban), and such.
RELATED: Pharmacy Deserts Leave Black and Latino Neighborhoods Without Accessible Healthcare
EH: How do we see disparities show up in the context of #cancer screening and treatment, and what can we do about it?
Erika Stallings: Black women experience disparities at all aspects of the breast cancer journey: Diagnosed at earlier ages, diagnosed when disease has advanced to a later stage, less likely to be offered a referral to genetic counseling and testing.
Prostate Cancer Foundation: Black men may not be aware of their increased risk for #prostatecancer. Hispanic or Latino men are less likely to get screened due to lack of educational materials in their preferred language and being less likely to have a regular doctor.
Disparities also exist in #prostatecancer diagnostics and treatment (delay, or receipt of guideline-appropriate care). It’s important to note that Black men do as well or better when access to care is equalized (such as in the VA system or clinical trials).
Sean Marchese: The most egregious disparities in cancer care occur during screening, or a lack thereof. Patients who can't afford regular doctor visits or expensive tests are more often diagnosed with late-stage disease. Advanced illness means fewer options.
EH: Has COVID-19 complicated or worsened disparities in cancer care?
Cancer Support Community: Yes, absolutely. COVID-19 exacerbated existing disparities: unemployment, loss of insurance or underinsurance, lack of transportation, and for people who work in low-income or high-risk jobs not receiving paid time off.
Baptist Health S FL: COVID-19 has delayed cancer screenings, surgeries, and patients seeking medical attention. Healthcare visits are done virtually, and we’re limited in examining patients and identifying issues at hand. (Sarah Joseph, MD)
RELATED: Cancer Trends: How Has the COVID-19 Pandemic Affected Cancer Screening?
EH: What can patients do to avoid disparities in cancer screening and care?
Touch, The Black Breast Cancer Alliance: We all must continue to educate. At @touchbbca we have an #HBCU [Historically Black College and Universities] internship program to educate young women. They are an entry point to family conversations and can bring info into families.
Cancer Support Community: Instead of asking what patients can do, we should ask what we in healthcare should be doing. Our helpline (1-888-793-9355) is staffed with licensed, caring professionals who help connect patients with vital resources around the country.
National LGBT Cancer Network: It should be required that doctors and other healthcare professionals be trained in racial and LGBTQ+ cultural competency. I cannot avoid that fact that I am a Black, queer woman. A provider can avoid being racist, transphobic, and insensitive.
RELATED: Why Are More and More Young People Being Diagnosed With Colorectal Cancer?
EH: What resources are available to people who want to learn more about disparities or cope with them?
LUNGevity Foundation: [Recommendations from the American Society of Clinical Oncology appearing in March 2021 in JCO Oncology Practice], published with experts including LUNGevity, provide a real-world, expert-informed framework to achieve #cancerhealthequity in medically underserved communities. Strategies might reduce disparities.
Baptist Health S FL: We must identify areas of mistrust amongst ethnic communities and work on restoring these relationships. (Sarah Joseph, MD, #MiamiCancerInstitute)
Cancer Support Community: Major news outlets have done some great reporting since the pandemic. Good places to start are @AmericanCancer (patient disparities) and @NA4Caregiving (caregiver disparities). Scientifically minded people can check out @theNCI or the Centers for Disease Control and Prevention (CDC).
RELATED: Closing the Gap in Breast Cancer Care and Support for Black Women