More attention is being focused on the differences in the occurrence, frequency, and survival of cancer of different populations in the United States. These populations may include members of minority populations, older adults of any race or background, and those who are poor or geographically isolated. Cancer.Net talked with Derek Raghavan, MD, PhD, to learn more about health disparities in cancer.

Q: What are health disparities and some of the factors that contribute to health disparities?

A: Although there are many relevant definitions, the U.S. Department of Health and Human Services defines health disparities as differences in the occurrence, frequency, death, and burden of diseases and other unfavorable health conditions that exist among specific population groups.

Factors contributing to these differences include poverty; lack of access to health care; lack of health insurance; language and literacy barriers; and poor expectations of the result of cancer treatment, the doctors, and/or the health-care system.

Q: What are some specific areas of disparity in cancer care?

A: Our current cancer prevention strategies for the various underserved population groups are inadequate. The same factors that may result in health disparities, such as poverty, lack of family support, social habits (smoking, lack of exercise), and attitudes and access to health care also affect participation in efforts to prevent cancer. Some studies show that minority women tend to be more reluctant to have mammograms or testing for the breast cancer genes (BRCA1 and BRCA2) when it is needed, which means they are much less likely to benefit from preventive care. Delays in diagnosis are another problem that contributes to disparities. Having access to and getting the best treatment is a problem for those people in minority or underserved populations.

Q: What are some interesting studies being done about/on cancer disparities?

A: At present, there are two major areas of work: (1) those specifically focused on service, with an attempt to improve the scope and quality of cancer care for underserved populations; and (2) research that is mostly directed to specific population groups (African Americans, Hispanics/Latinos, older adults, and impoverished or isolated groups).

Specific studies of interest include:

• Studying the cultural issues and reasons for a lower use of screening tools for cancer by African American men and women
  
  
• How chemotherapy affects people over the age of 70
  
  
• Cervical cancer vaccine studies with Hispanic/Latina women
  
  
• How best to manage prostate cancer among African American men

Q: What is ASCO doing to reduce disparities in cancer care?

A: Some initiatives ASCO is undertaking or considering include the following:

• Holding educational sessions about cancer disparities at the ASCO Annual Meeting (the premier educational and scientific event where physicians, researchers, and other health-care professionals gather to discuss the latest in cancer care)
  
  
• Providing mentorship opportunities to college students, medical students, and hospital staff to guide and advise interested people to a career in cancer medicine and cancer research
  
  
• Allocating funds for specific research in the disparities of cancer care and cancer in minority populations
  
  
• Providing fellowships for the training of minority or under-represented population groups

Q: What does this mean for people with cancer?

A: Ideally, this approach should remove deficits in access to cancer care, so that underprivileged populations, those with linguistic, geographical, or financial barriers, or those from specific racial or ethnic groups will have the same access to high-quality care as the rest of the population. This can be achieved by encouraging and training more oncologists from minority groups, providing specific training on culturally sensitive care, and improving education about cancer and prevention. We also could see better treatments that are specific to populations with unique needs, while advancing our understanding of the cancer issues relating to those populations.

Dr. Raghavan is Director of the Taussig Cancer Center and Chair, Cancer Division at Cleveland Clinic. He serves as Cancer.Net Associate Editor for genitourinary cancers and is Co-Chair of the ASCO Health Disparities Task Force.

Additional Resources

American Cancer Society: Cancer Disparities: Key Stats

National Cancer Institute: Cancer Health Disparities

National Cancer Institute: Center to Reduce Cancer Health Disparities

More Information

ASCO Expert Corner: Race and Breast Cancer