A new report from the President's Cancer Panel identifies an "urgent need" to expand research and improve understanding of the factors that influence cancer risk and outcomes among diverse populations.
The report, "America's Demographic and Cultural Transformation: Implications for Cancer," says that since knowledge of cancer risk, incidence, progression, and outcomes is based largely on studies of non-Hispanic white populations, the current understanding of risk factors, screening guidelines, and treatment may thus not be appropriate for individuals of non-European descent.
The Panel also calls for higher standards of "cultural competence" among health care professionals to better address cultural and language barriers that can negatively affect the quality of patient care.
"As the cultural landscape of our nation continues its transformation, the one-size-fits-all approach to cancer screening guidelines, prevention, and treatment is no longer appropriate," said Panel Chair LaSalle D. Leffall, Jr., MD, the Charles R. Drew Professor of Surgery at Howard University College of Medicine. "A more accurate understanding of cancer risk factors among diverse populations and improved training in cultural competency are critical steps toward reducing the national burden of cancer."
The report notes that cancer incidence among minority populations is projected to nearly double between 2010 and 2030, further emphasizing the need for a more accurate assessment of the effects that a changing demographic will continue to have on cancer incidence and mortality in the coming decades.
Key Findings
The key findings and recommendations of the report are as follows:
* While the impact of socioeconomic and sociocultural determinants of health outcomes has long been recognized, cancer research has focused primarily on using genetics to identify health differences. The Panel recommends that both biologic and sociologic factors be examined to truly understand diverse populations and resulting health disparities.
* There is a need to evaluate current cancer screening guidelines to determine their accuracy in assessing disease burden in diverse populations. In particular, the report recommends that researchers consider the patient population in its entirety and identify common genetic, sociologic, and environmental risk factors on which to base screening recommendations.
* Researchers must examine the impact of changing demographics and expand the current understanding of related factors that influence cancer risk, incidence, and mortality. This knowledge must then be applied for the benefit of all subpopulations so that more accurate preventive measures can be implemented.
* The majority of health care providers do not adequately consider patient sociocultural and socioeconomic characteristics when addressing cancer prevention and treatment, even though these factors can have independent and sometimes profound effects on cancer susceptibility and outcomes in both native and foreign-born Americans. In addition, the Panel found that patient-provider language differences are a significant barrier to the provision of quality health care. The Panel recommends that cultural competency become an integral part of medical and research training curricula, as well as a continuing education requirement. Also recommended was that trained interpreters be viewed as essential members of the health care team.
* Though personalized medicine for all is the ultimate goal in cancer care, it is not universally feasible or affordable in the near future, the report said. Research is therefore needed now to identify subpopulations at high risk of disease due to genetic/ancestral, biologic, sociocultural, and other factors that directly relate to risk or response to therapy.
* Weaknesses in existing vital statistics, census, public and private insurer, and cancer surveillance data may thwart efforts to characterize populations in a scientifically meaningful way. To address these serious data deficiencies, the Panel called for improvements in data collection, as well as standardized data sets and definitions of race and ethnicity.
* There is a need for improved data sharing among government agencies at all levels as well as a need to address issues of data compatibility.
* Additional recommendations include increasing the diversity of the cancer research and care workforces; exploring and evaluating the benefit of patient navigation models; and continuing basic, translational, clinical, population, and dissemination research on cancer health disparities.
The Panel concluded that cancer and other health disparities will be eliminated only when the social determinants of poor health outcomes, such as poverty, low educational attainment, substandard housing and neighborhoods, and insufficient access to quality health care, are adequately addressed.
In addition to Dr. Leffall, the three-member President's Cancer Panel also includes Margaret L. Kripke, PhD, Professor of Immunology and the Vivian L. Smith Chair Emerita at the University of Texas MD Anderson Cancer Center. The third seat, which until recently was held by Lance Armstrong, is currently unfilled.
The Panel, established by the National Cancer Act of 1971, is an independent entity charged with monitoring the National Cancer Program and reporting annually to the President on any barriers to its execution.
Otis Brawley: Genetics Not Whole Story
In a statement, the American Cancer Society's Chief Medical Officer, Otis W. Brawley, MD, called the report "a well-developed synthesis of the issue of disparities in health, and a "landmark report," but cautioned that there is still much to be learned about factors related to culture, habits, and the environment.
"The publication rightly describes cancer as a problem that is worse in certain populations be they defined by race/ethnicity, socioeconomic status, or area of residence (rural vs urban)," he said. "The expansion of the issue beyond Black/White race is especially important. Population biologists need to help medical science in meaningful categorization of the population as we assess cancer impact and the outcomes of cancer control programs.
"Overwhelmingly clear is the fact that in order to advance our control of this disease we must understand the role that culture, habits, and environment play in cancer causation and the cancer treatment experience," Dr. Brawley continued. "We must also understand that the role of genetics in cancer is significant but it is not the whole story, and we must not let that blind us from seeing other factors at work here. The report clearly points out that race is a social and not a biologic construct, a point few Americans understand.
"The publication notes that some trends are very favorable at this time. Cancer mortality rates are trending downward faster among African Americans than among whites, and if this current trend continues, the disparity may disappear in the next 20 years.
"At the same time it is clear that a significant portion of the American population, however one defines them, is currently not receiving adequate cancer prevention and adequate cancer treatment. Interventions to provide access to adequate care to those who do not get it is imperative as American lives are being lost as a result."