Cancer prevention for minority populations -
These patients are not receiving the quantity and quality of screening required to achieve consistent early detection of their cancers. One of the most commonly cited barriers to early diagnosis with cancer screening among Blacks and Hispanics is the quality of care they receive.
This is particularly true for women seeking breast cancer screening. On average, white women are more likely than Black or Hispanic women to have mammograms at academic facilities, facilities that rely exclusively on breast-imaging specialists to read mammograms and facilities where digital mammography is available.
One study found that these differences in screening facilities accounted for most of the discrepancies in late-stage diagnoses between Black and white women, after controlling for neighborhood.
Another likely cause of disparities in early cancer diagnosis between white and Black patients is the higher rate of more aggressive tumor types among minority patients. For example, in breast cancer there is a higher incidence of triple-negative tumors TNT among Black women compared to white women.
The current guidelines from the USPSTF are for biennial breast cancer screening in all women ages 50— These guidelines were set after reviewing the benefits and risks of mammogram technology and balancing the potential of earlier diagnosis with the high potential for false-positive test results.
However, TNTs progress to late stages faster than other tumors, and the two-year gap may be too long for early diagnosis in these more aggressive tumors. Similarly, among colon cancer patients, Black and Hispanic Americans, on average, are diagnosed at a younger age with a more aggressive form of the disease than whites.
Finally, financial barriers may also prevent minority patients from receiving adequate cancer screening. In principle, MCED blood-based tests can address several of the current challenges in cancer screening within minority communities.
For example, the tests do not require specialist visits and primary care physicians can use MCED blood-based tests to start a conversation with patients about cancer risks and determine when and how often to test.
Currently, the false-positive rate of mammograms makes it too risky for physicians to recommend more frequent usage among patients, but MCED blood-based tests feature high specificity and little burden on the patient in terms of additional appointments.
Colonoscopies require extensive and uncomfortable colon cleansing and are expensive; it may not be realistic to recommend them more frequently, but regular MCED blood-based tests could be effective in detecting aggressive tumors between procedures.
MCED blood-based tests can also be used in younger patients at high cancer risk before other types of screening are recommended. The tests are not tumor-specific, so one blood test could screen younger patients for a number of different cancers with little risk or discomfort.
The false-positive rates specificity are so low for these tests that the risk of wasteful follow-up testing is limited. The quality of the lab-based blood test is also more likely to be uniform regardless of the physician office where the test is administered, thereby avoiding the discrepancies in patient care found across other types of screening centers.
This will also be important in evaluating the potential of MCED blood-based tests to address the tremendous unmet need in unscreened cancers.
The quality and consistency of results may be easier to achieve, but equity in early diagnosis can only be achieved if all patients have broad access to the tests. In fact, if patients do not have equitable access, these tests could mainly benefit advantaged communities and thereby exacerbate existing disparities in early detection and create new inequalities in previously unscreened tumors.
Economic and cultural factors limit access to cancer screening and erode trust in the healthcare system among minority patients.
As a result, minority patients are less likely to have their screen-available cancers diagnosed at early stages where treatments are most successful. The goals of health policy should be to eliminate these barriers and improve trust in screening in minority communities.
However, these cultural and systematic changes may be achieved only slowly over time even in a best-case scenario. In the meantime, MCED blood-based tests may offer hope to overcome some of the disparities because they can be a flexible tool for physicians in the battle to reduce or eliminate barriers to screening within minority communities.
For example, MCED blood-based testing can be offered through primary care physicians without the need for a referral or separate visit to a specialist. In rural communities, access to specialists can be limited, increasing the benefits of convenient blood-based tests for minority patients.
All blood samples would be sent to a central lab for processing, ensuring consistent quality and accuracy of the results regardless of where the sample was drawn. The new tests could be offered between current recommended screenings to reduce the risks caused by more aggressive tumors that afflict minority communities at higher rates than the general population.
The tests are not tumor-specific and could therefore offer broad cancer screening between recommended screenings. For example, women at high risk for breast cancer could have MCED blood-based tests between biennial mammograms. MCED blood-based tests could also be used to start screening minority populations for cancer, including colon cancer, at a younger age.
Despite the potential of MCED blood-based tests to increase cancer screening and reduce racial disparities, realization of its promise is far from certain. It will depend on whether access is provided broadly to minority patients and whether physicians use the tests equally for all patients at high risk of cancer.
If test adoption is lower among physicians in minority communities, or if insurance coverage is lower among minority patients, then MCED blood-based testing could increase racial disparities in early cancer detection rather than reducing them.
As MCED blood-based tests are introduced, more research will be needed to track their use and understand their real-world impact on barriers to cancer screening.
The views expressed herein are those of the authors, and do not represent the views of the funders. The Schaeffer Center is supported by a wide variety of public and private entities and donors, including companies developing blood-based tests for cancer. Lakdawalla reports personal fees or research support from Amgen, Biogen, Genentech, GRAIL, Edwards Lifesciences, Novartis, Otsuka, Perrigo, and Pfizer and holds equity in Precision Medicine Group, which provides consulting services to firms in the life sciences.
This paper has undergone the Schaeffer Center white paper quality assurance process, led by Emmett Keeler, Schaeffer Center Senior Fellow and Quality Assurance Director.
In addition to his review, the paper was reviewed by two scholars not affiliated with the Schaeffer Center. You must be logged in to post a comment. Skip to content Key Takeaways Economic and cultural factors limit access to cancer screening and erode trust in the healthcare system among minority patients.
Multi-cancer early-detection blood-based tests may mitigate disparities in early cancer diagnosis experienced across minority communities if offered in collaboration with regular screening schedules to detect aggressive tumors that afflict minority patients at higher rates than the general population.
MCED tests may also mitigate disparities by eliminating the need for access to specialists and ensuring consistent quality and accuracy of test results, thereby reducing discrepancies in patient care found across other types of screening.
If test adoption is lower among physicians in minority communities, or if insurance coverage is low, then multi-cancer early-detection blood-based testing could disproportionately benefit white patients and increase, rather than reduce, racial disparities in early cancer detection.
Abstract Despite universal recommendations from the U. Introduction Racial and ethnic disparities in cancer mortality and diagnosis represent significant problems for the U. Barriers to Screening Minorities As these early-detection statistics show, minority patients are not fully benefiting from the USPSTF screening recommendations and their cancers in some cases are slipping through the cracks.
Conclusion Economic and cultural factors limit access to cancer screening and erode trust in the healthcare system among minority patients. References DeSantis, C. CA Cancer J Clin, Ward, E. CA: a cancer journal for clinicians, Crosby, D. The Lancet Oncology, The American Cancer Society medical and editorial content team.
Lung Cancer Survival Rates. Survival Rates for Breast Cancer. Fiscella, K. BMC Health Services Research, Siegel, R. Although cancer incidence and mortality overall are declining in all population groups in the United States, certain groups continue to be at increased risk of developing or dying from particular cancers.
Some key cancer incidence and mortality disparities in the United States include:. Cancer health disparities happen when there are higher rates of new diagnoses and cancer death rates among certain races, ethnicities, or other population groups. Share this video to help others learn about cancer health disparities in the United States.
Cancer disparities reflect the interplay among many factors, including social determinants of health, behavior, biology, and genetics—all of which can have profound effects on health, including cancer risk and outcomes. Certain groups in the United States experience cancer disparities because they are more likely to encounter obstacles in getting health care.
People who do not have reliable access to health care are also more likely to be diagnosed with late-stage cancer that might have been treated more effectively if diagnosed at an earlier stage. Some groups are disproportionately affected by cancer due to environmental conditions.
People who live in communities that lack clean water or air may be exposed to cancer-causing substances. For example, people who live in neighborhoods that lack affordable healthy foods or safe areas for exercise are more likely to have poor diets , be physically inactive , and obese , all of which are risk factors for cancer.
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Cancer Disparities in the Black Community. Research has shown that: African Americans experience more illness, worse outcomes, and premature death compared to whites. African American men also have the highest cancer incidence. Cancer death rates in black men is twice as high as in Asians and Pacific Islanders, who have the lowest rates.
About a third of African American women reported experiencing racial discrimination at a health provider visit. Living in segregated communities and areas highly populated with African Americans has been associated with increased chances of getting diagnosed with cancer after it has spread, along with having higher death rates and lower rates of survival from breast and lung cancers.
Despite universal pevention from mnority U. Preventive Autophagy and autophagosome formation Task Warrior diet recipes for routine screening for breast, Nutrient timing for vitamins and minerals and colon cancers, minorkty and ethnic minorities popupations less likely to receive these screenings and more likely to be Autophagy and autophagosome formation with cancer prevehtion later stages than their Mihority counterparts. Ofr that one of the most important prognostic factors for cancer remains the stage of disease at initial diagnosis, screening disparities may be contributing to disparities in cancer mortality suffered by Black and Hispanic Americans. The advent of multi-cancer early-detection blood-based tests, which can detect the presence of previously unscreened cancers, may help mitigate some of these disparities. In this paper, we summarize current screening systems and existing disparities in early detection. We then explore whether access to multi-cancer early-detection blood-based tests could expand access to screening and reduce racial and ethnic disparities. African Prveention suffer Cancer prevention for minority populations more cancer morbidity and mortality than the white population. In order to decrease this populationz, it Caancer critical po;ulations understand the particular barriers to health Antioxidant supplements for hair and nails health care populationw underserved Ppopulations Americans face. It is also fo to Hormonal imbalances and acne the critical components of effective cancer prevention programs for this population. The barriers that impede care for underserved African Americans have been identified as: 1 inadequate access to and availability of health care services; 2 competing priorities; 3 lack of knowledge of cancer prevention and screening recommendations; 4 culturally inappropriate or insensitive cancer control materials; 5 low literacy; 6 mistrust of the health care system; and 7 fear and fatalism. Effective programs must incorporate community participation, innovative outreach, use of social networks and trusted social institutions, cultural competence, and a sustained approach.
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