Senior Editor, OncLive®
Hayley Virgil heads OncLive's feature article efforts and specializes in social issues and equality in oncology. Prior to joining the company in early 2020, she worked as an editor in numerous industries, including media, marketing, hospitality, and computer science, and freelanced in subjects such as history, culture, and the natural sciences.
Anita Johnson, MD, FACS, discusses existing disparities in cancer, studies that have helped to shed further light on the issue, and ongoing efforts being made to improve outcomes in all patients.
Disparities in cancer incidence and outcomes by race and ethnicity continue to exist in the field of oncology, but cultural competence, multidisciplinary efforts with diverse faculty, and high-risk screening programs could help to address critical gaps, according to Anita Johnson, MD, FACS.
“We know that prostate cancer is very common in Black men, and when we look at breast cancer detection in Black women, we know they present at a later stage; [however], that has not been done is really enforcing high-risk screenings at the primary care level.” Johnson said. “We oftentimes see women who come in [who] have several family members with breast cancer, but they have never been sent to a high-risk clinic. That is where I believe we could have a significant impact.”
In an interview with OncLive®, Johnson, a breast surgical oncologist and the Breast Cancer Program director at Cancer Treatment Centers of America, discussed existing disparities in cancer, studies that have helped to shed further light on the issue, and ongoing efforts being made to improve outcomes in all patients.
Johnson: I have been a breast cancer surgeon for over 25 years and I have seen disparities even before I became a surgeon. I trained at one of the foremost indigent hospital systems, Grady Hospital System, and observed patients coming in with late-stage diagnosis, whether it be cancer or advanced hypertension. We oftentimes see patients who are underinsured, who do not [typically] have access [to care], present with late-stage disease. [This is something that] has been going on for hundreds of years.
Several studies have been done, [but] one study done by the National Cancer Institute last year [specifically] reviewed disparities in oncology. As we know, when we compare death rates among several cancers, the rates are significantly higher [with] African Americans compared with Caucasians. Breast cancer is one of [these cancers in which this is the case].
We know that when we look at the incidence of breast cancer rates, it is equal among Black and White women, but when we look at the death rates, [they are] significantly higher for African American women stage for stage. The same [goes] for prostate cancer. The good news is that the death rates [associated with prostate cancer] are declining, but the bad news is that Black men have twice as high of a chance of dying from prostate cancer than White men. When we look at cervical cancer, Hispanic women and Black women have higher incidence rates, but Black women continue to die at a higher rate. Those are [some of the] disparities [we see] when we look at oncology, [overall].
[With our] hospital system, our model is multidisciplinary. I actually submitted an abstract about 2 to 3 years ago to the Society of Surgical Oncology that looked at whether there] was a difference in treatment when it comes to patients with breast cancer, and there was no known difference. In our hospital system, all the patients are offered the same treatment. We do not have an isolated group. We review all our patients before they arrive and we follow national guidelines, [which] do not necessarily discriminate with screenings. We offer all our patients standard-of-care treatment options.
We still struggle as a hospital system because it is not only the treatment that is needed; [we also need to have] providers who are culturally competent and are able to have t difficult conversations. As we know, some ethnic groups look at cancer care or being diagnosed with cancer as being fatal. We know that the diagnosis, the treatment, and the surgery [approaches in this disease] have changed.
When it comes to oncology care, we are all humans. Being culturally competent is really important. It needs to start with medical school, [as it] depends on where you train and whether you are used to a diverse population. When we talk about hiring oncologists, we must make a sincere effort to hire those who will represent those populations.
[This also holds true for] advanced nurse practitioners and healthcare leadership, such as hospital chief executive officers. [We need to make] a significant effort [in this regard]. It also comes down to employers. Patients who are gainfully employed and who are well insured have more access to screenings, diagnosis, and early detection, which definitely impacts overall survival.
ASCO is going to reiterate the disparities that are being seen among different groups and it will also shine a light on the COVID-19 pandemic. With the work environment being different, with some individuals being underemployed, we expect to see more patients present with late-stage disease. At this point, when it comes to healthcare among all specialties, telehealth will have a huge impact, [as well as] access to screenings. We need to step that up and become advocates of policy changes. [For] patients who have significant family histories, we need to ensure that they are placed in a high-risk program so that they are screened more frequently than those who do not have a significant history.