Mariana C. Stern, PhD, discusses the biggest gaps identified in the 2026 AACR Cancer Disparities Progress Report and what oncologists can do to combat them.
Despite leaps and bounds of progress in narrowing societal gaps for cancer care, there is still considerable ground to be made as new gaps regarding access begin to widen for the oncology field, according to Mariana C. Stern, PhD.1
“The common thread that we see across most of these disparities is access: access to screening, early detection, care, and clinical trials,” Stern said in an exclusive interview with OncLive®. “A key message is that disparities not only affect the communities that suffer them; they affect everyone.”
Stern is a professor of clinical population and public health sciences, the Ira Goodman Chair in Cancer Research, associate director for population sciences at the University of Southern California (USC) Norris Comprehensive Cancer Center, and vice chair for culture and engagement at the Keck School of Medicine of USC in Los Angeles, California.
Cancer mortality rates have long been higher among Black patients than among White patients; however, the report notes that this gap has narrowed from 34% in 1991 to 9% in 2024. Moreover, since 2000, cervical cancer mortality rates between Hispanic and White women have also considerably narrowed.
“These accomplishments reflect the investments that were made in trying to understand those disparities and deploying initiatives and interventions to reduce them, further highlighting the importance of focusing on this field,” Stern said. “[Reductions in cervical cancer mortality rates are] a great reflection of the progress that has been made in terms of understanding the root causes of these disparities and deploying initiatives to reduce them, which mainly have to do with increased vaccination and increased screening and early detection.”
Other notable disparities that have narrowed since 2000 include gaps in stomach cancer mortality between Asian or Pacific Islander and White populations and in lung cancer mortality between White and Black men.
“What [these narrowing disparities are] telling us is that the initiatives that have been put in place are working right now,” Stern said.
Effective approaches in narrowing these disparities, as highlighted by the report, include culturally and linguistically tailored interventions, improved patient navigation, programs promoting healthy behaviors in communities, and expanded access to health care via legislation and public policy.
Although lasting disparities in cancer between racial and ethnic groups have narrowed with recent progress, new ones have recently arisen.
“Black, American Indian, and Alaska Native communities still bear the greatest burden of cancer, with the highest overall cancer death rates compared with any other group in the US,” Stern said. “These remain big disparities for these communities; a cross-cutting fact across all these diverse disparity communities is that every single racial and ethnic minority group has about a 5-year lower survival compared [with] White populations.”
Furthermore, divides between other groups such as gender and sexuality minorities and those who live in rural areas have begun to spread. “When we look at disparity populations, we not only look at racial and ethnic minorities, [but] we also look at other disparity populations that include members that represent the entire country,” Stern said.
For example, the report notes that lesbian women are nearly twice as likely as heterosexual women to be diagnosed with thyroid cancer or non-Hodgkin lymphoma, rural residents are 27% more likely than urban residents to die of colorectal cancer, and cervical cancer mortality is 49% higher among women in persistent-poverty counties than among women in counties without persistent poverty.
A particularly striking developing disparity that Stern and the report underscored is the rising early-onset colorectal cancer diagnosis in younger patients.
“The other emerging disparity we see that is of great concern is that…early-onset colorectal cancer is rising across all racial and ethnic groups. This is a diagnosis among very young people who don't qualify for screening. They're not being screened, which means they typically tend to be diagnosed at an advanced stage because by the time they realize they have something, it’s because they have symptoms; then typically, that goes along with a higher stage [in their diagnosis],” Stern said.
Structural changes for the field of oncology and society in general are pivotal in not only addressing the current disparities at hand but also proactively preventing the engendering of new ones, according to Stern and the report. More granular data, analyses, and trials focused on all marginalized groups, along with greater access to clinical trials and resources, are but a few of the structural improvements that the field of oncology can make to bridge gaps in disparities.
“We need to continue collecting data, and we need to make those data as granular as possible so that we can identify the most pressing disparities…. Providing access to care is a key barrier to address,” Stern said. “In terms of what we can do [in day-to-day practice to address disparities], we see that only a small percent of patients are participating in clinical trials. Clinical trials are the fastest way for patients to have access to more innovative drugs. We need to increase the number of patients who participate across the entire spectrum in the US.”
Stern also shed light on Vanessa Bañuelos, a 34-year-old patient with acute lymphoblastic leukemia highlighted in the report’s Survivor Spotlights. Stern explained how Bañuelos’ diagnosis was unexpected, creating a stressful environment with limited resources for her to turn to and subsequently causing her to make difficult decisions regarding her fertility.
“Bañuelos was a young woman living her life, then she gets diagnosed, and all of this information comes to her. They discussed with her the issue of fertility and preserving her eggs before she underwent chemotherapy, but there was so much else going on, and the cost was so high to do any of these things…. She's in remission, which is wonderful, but now she doesn't have her fertility anymore,” Stern said.
Bañuelos’ story speaks to the value of increased access and resources not only in narrowing disparities among younger patients but also in improving their ability to live normal lives. Moreover, Stern pointed to a study of the Veterans Health Administration, in which veterans across all populations are provided equal access to the same quality of care through integrated systems and networks and experience similar outcomes.
Survivorship stories and studies solidify the efficacy of increasing access and other broader efforts to narrow cancer care disparities, but implementing these initiatives is often met with costly concerns. However, Stern and the report highlight how these initiatives might reduce costs and economic burdens rather than raise them.
“If we just focus on racial and ethnic inequities, the excess burden of cancer, death, cancer incidence driven by these disparities that we know exist [incurs] a cost to the US economy that is over $400 billion per year. This is money that we could be saving if the disparities did not exist,” Stern said. “It's not only a moral responsibility helping the communities that are suffering, but it's also a fiscal responsibility.”
On top of reducing costs, Stern argued that better representation and access to services such as clinical trials will also help make novel therapies more effective.
“We need to have representation in cancer research studies because those are the studies that lead to the development of new drugs that then are tested in clinical trials. If drugs are developed with cell lines and samples from patients that only represent one community in the US, then we are never going to understand how those drugs are going to perform in others,” she said. “We need to really ensure that we have representation, not just in clinical trials but in basic cancer research.”
