Minorities @ Greatest Risk Of Dying From Cancer.

With mounting evidence that minorities and the poor are experiencing higher rates of cancer and are dying more frequently and more quickly from this disease, the Intercultural Cancer Council Caucus (ICCC) issued a 12-step action plan outlining how the Administration and the U.S. Congress can begin to eliminate the many disparities in cancer care now experienced by the medically underserved.

In conjunction with ICC’s 9th Biennial Symposium on Minorities, the Medically Underserved, and Cancer held in Washington, the ICC Caucus released a new report — From Awareness to Action: Eliminating the Unequal Burden of Cancer — that provides realistic goals for addressing this growing public health problem. Issued as a nationwide call to action, the report states that unless more is done to address the unequal burden of cancer faced by ethnic minorities, the elderly and the poor, “the potential exists for an even larger gap in quality cancer care where millions of minorities and the poor will not reap the benefits of advances in cancer prevention, detection and treatment.”

The new report, designed to provide the most up-to-date information about disparities in cancer rates and death among the nation’s minorities and the poor, concludes there are major disparities in access to quality cancer care at all points in the process — from screenings and diagnosis to access to state-of-the-art cancer therapies and end-of-life palliative care.

Specifically, the report reveals a widening gap in the incidence and death rates among minorities and the poor for all cancers compared to the general population. Compared to 1975 when total cancer death rates for men was only two percent higher in high poverty areas than in the more affluent regions, by 1999 the gap had jumped to 13 percent.

Further, the report reveals a disproportionate number of cancer deaths occur among racial/ethnic minorities and the poor, particularly African Americans and Alaska Natives who have the greatest risk of dying from cancer in the U.S., followed closely by Native Hawaiians. The report also finds that many poor Whites have cancer diagnosis rates as high as or higher than those for ethnic minority groups most affected by the disease.

“As the nation considers reforms to the health care system, no workable agenda can ignore the pressing issue of combating disparities in cancer care,” said Lovell A. Jones, Ph.D., co-founder of the ICC. “An intensified focus on providing quality cancer care for all Americans is essential to winning the war against cancer.”

Although it is now estimated that more than half of all cancers can be prevented though improvements in lifestyle, the report finds major disparities in primary cancer prevention, such as smoking cessation and improved dietary habits. Looking directly at tobacco use, which accounts for at least 30 percent of all cancer deaths and 87 percent of lung cancer deaths, the report states that smoking is especially prevalent among the disadvantaged. More people in households with incomes of less than $25,000 smoke cigarettes compared to households with incomes of $25,000 or more (35.5 percent vs. 26.5
percent). Further, the report finds that smoking is on the rise among African American and Asian American youth. Among African Americans, 34 percent of young men and 23 percent of young women smoke while in Asian American and Pacific Islander communities, there has been a seven-fold increase in smoking rates in the middle schools (4.4 percent) and high schools (33.1 percent) — the highest increase for any U.S. ethnic community.

What is equally disturbing, according to the new report, is that minorities and the poor are less likely to be screened for cancer and therefore, are more likely to have late-stage cancer when the disease is diagnosed. Here, the review finds that only 66 percent of American Indian/Alaska Native women 60 years or older have ever had a breast exam and only 38 percent of Hispanic women aged 40 plus have regular screening mammograms. At the same time, the report reveals that Asian American,
Hispanic, low income and less educated women are less likely than the general population to get Pap smears, greatly increasing their risk of being diagnosed with invasive cervical cancer.

At the same time, ICCC’s review points to major disparities in how the medically underserved receive cancer care, including access to cancer clinical trials and treatment with newer, more targeted cancer therapies. Documenting the extent of the problem, the report reveals that women with breast cancer are less likely to be treated with breast-conserving surgery (BCS) and radiation if they live in poor communities. Likewise the report concludes that African Americans diagnosed with stage I or stage II non-small cell lung cancer are less likely to receive recommended surgery than Whites.

According to the report, a major factor behind these disparities is the prevailing societal and institutional racism. While overt racism is seldom practiced or observed in today’s medical setting, the report finds that a “deep-rooted institutional memory of racism” permeates the nation’s health policies and practices, as well as in the personal attitudes and perceptions of health care providers and researchers.

Also addressed in the report is access to pain management and palliative care at the end of life, two areas where disparities in cancer care are significant. Specifically, the ICCC review finds that metastatic cancer patients at centers that treat predominantly minorities are three times more likely than those treated elsewhere to have inadequate pain management. The report further shows that research in cultural quality-of-life issues, including pain symptom management, has been neglected. Most pain literature acknowledges that culture influences cancer pain management, yet little empirical work has been conducted in this area.

“To improve this situation requires changing the future, which means moving with urgency to reduce the unequal burden of cancer now faced by the nation’s minorities and the medically underserved,” said Alexine Clement Jackson, ICC’s Chairman. “Clearly, enough information now exists to address this problem head on — through policies that will provide ethnic minorities and the medically underserved with greater access to services and programs that are designed to prevent, detect and treat cancer at its earliest stages and while supporting these individuals through and beyond treatment.” To begin to change these statistics, the ICC Caucus has created a 12-point action plan to provide vulnerable populations with greater access to programs that will prevent, detect and treat cancer at its earliest stages while supporting these individuals through and beyond treatment. Specifically, the organization is calling on the Administration and the U.S. Congress to take immediate action in these areas:

1. Fully implement and fund the recommendations of the Trans-DHHS Cancer Health Disparities Progress Review Group’s report, Making Cancer Health Disparities History. This report contains 14 recommendations that will mobilize the government’s available resources to eliminate cancer disparities.

2. Pass the Patient Navigator, Outreach and Chronic Disease Prevention Act in this session of Congress. This bill would
ensure that all Americans have equal access to prevention, screening and treatments for their disease along with an advocate to help them navigate through today’s complicated health care system.

3. Enhance the collection of data that will better describe racial, ethnic and socioeconomic diversity in cancer care in the U.S. 4. Increase federal funding for government programs that provide greater access to cancer screening programs.

5. Acknowledge and then move quickly to fully redress and monitor institutionalized racism as a major factor in the excess burden of cancer borne by our nation’s minority and medically underserved communities.

6. Make tobacco control a priority concern, backed by new federal and state initiatives that are specifically targeted to minorities and the medically underserved.

7. Eliminate the barriers to more effective pain management and palliative care for minorities and the medically underserved. 8. Increase the level of knowledge about cancer survivorship among the medically underserved.

9. Restore Medicare reimbursement for cancer treatment and cancer care in all settings this year.

10. Immediately implement and increase the funding for the Medicare demonstration project providing access to oral chemotherapy drugs.

11. Enact the Patients’ Bill of Rights to provide strong comprehensive protection to all cancer patients in managed care plans.

12. Achieve universal health insurance and establish a schedule to reach this goal by 2010.

“Creating a public policy agenda that focuses on eliminating the disparities in cancer care must occur immediately if we are going to eliminate the unequal burden of cancer experienced by minorities and the poor,” concluded Jennie R. Cook, President of the ICC Caucus. “The action plan advocated by the ICC Caucus will make the difference in the lives of many
Americans.”

The Intercultural Cancer Council Caucus is an advocacy organization whose mission is to advance policies, programs, partnerships and research to eliminate the unequal burden of cancer among racial and ethnic minorities and
medically underserved populations.