Closing the racial gap in cancer care
By Shirley E. “Bella” Borghi
Co-Vice chairman and Executive Director of the Hispanic Health Coalition of Georgia.
There are no silver linings in a pandemic that has claimed over 180,000 lives and wiped out millions of jobs, but COVID-19 has prompted a broadening of thinking regarding the state of healthcare in our country. There is a strong awareness that the coronavirus has had a disproportionate impact, in both cases and death tolls, on Hispanic/Latinos and African Americans, which is leading to a deeper understanding that this health gap has been in effect long before social distancing became a part of our lives. As a healthcare advocate for Latinx Hispanic/Latino communities, I welcome the flood lights being shown on this life and death issue. With awareness should come a resolution that we pursue actions to ensure that the quality of our health should not be tied to race, culture, or ethnicity.
Looking at cancer, for example, we can see some of the same racial, cultural, and ethnic disparities that have been so prevalent during COVID-19. Some of the reasons are easy to ascertain. According to the federal government’s Office of Minority Health, Hispanic/Latino women are less likely to have a mammogram than non-Hispanic white women and the Hispanic/Latino population as a whole has significantly fewer colonoscopies performed than their white counterparts. For any number of reasons – lack of health insurance, fewer community healthcare providers, lack of available transportation – Hispanic/Latino are receiving fewer health screenings and, consequently, too many cancers are detected when earlier, more effective treatment is no longer an option.
But the problem goes beyond that, to limitations within our cancer screening infrastructure itself that tilt disproportionately against minorities.
Today, there are routine screenings for only five types of cancer – breast, cervical, colorectal, “high risk” lung, and prostate. Hispanic/Latinos are hit particularly hard by types of cancer that don’t fall into these five categories. Our rates of liver cancer, both number of cases and death rates, are double those of whites. And, according to the federal government, Hispanic/Latino women are 2.4 times more likely to die from stomach cancer than white women.
I am hopeful that advances in medical science may help us close the racial disparity cancer gap, but we have to be ready to make those innovations widely accessible once they are approved for use.
Right now, for example, there are clinical trials underway utilizing cutting-edge machine learning and the knowledge gained from genomic research, that have detected and localized dozens of cancer types from a single blood draw. It’s an understatement to say this would transform our ability to combat the disease. Today, nearly three of every four cancer deaths are from a variation of the disease that we’re not detecting at an earlier, more treatable stage because screenings aren’t available. Better detection tools could save the lives of those aforementioned people who are dying from stomach or liver cancer.
Just as importantly, advances in screening technology could expand the socioeconomic reach of early cancer detection. In some less privileged and rural communities, there may not be easy access to recommended screenings like mammography or colonoscopy. A simple blood draw, however, could help level the playing field and make cancer screening more widely throughout the country.
Again, though, this realistic vision of a better healthcare future is contingent upon policymakers and other key stakeholders laying the groundwork now for cancer detection innovations coming down the pipeline in the near future. Once a multi-cancer early detection breakthrough becomes available, it is critical that it also be widely accessible, yet troubling barriers to coverage exist particularly for seniors in the Medicare program.
COVID-19 has opened America’s eyes to a racial and cultural gap that has long existed in health and healthcare. Our willingness to close that gap for cancer early detection will speak volumes as to where we stand as a society.