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What’s driving racial disparities in cancer outcomes?

While patient outcomes in cancer have been improving, continuing racial disparities in cancer care and outcomes are concerning. African Americans experience the highest cancer death rates and shortest survival of any racial/ethnic group for most cancers, the American Cancer Society reports. While disparities in cancer death rates have decreased for lung and prostate cancers in men over the past few decades, the gap has widened for breast cancer in women and remained the same for colorectal cancer in men. 

Differences in survival rates between black and white cancer patients have long been proven as resulting from barriers to access, lower-quality care, and socioeconomic disparities associated with race — not from biological differences. And yet, the idea that racial disparities are genetic is still a dominant and damaging viewpoint in medicine, write researchers from Brigham and Women’s Hospital Dr. Junaid Nabi and Dr. Quoc-Dien Trinh in an opinion piece in The BMJ.

“For far too long, research on race based disparities in cancer outcomes has focused on biological (or genetic) differences between black and white patients—and not our health system,” write Nabi and Trinh. This stereotypical narrative impedes progress, because it ignores the differences in the ways patients are treated in the health care system based on race.

Nabi and Trihn give many examples of these differences, from lower rates in definitive breast cancer therapy for black women, to fewer colonoscopies for black men, to higher rates of uninsured for people of color  after the Affordable Care Act. Even more telling, the authors cite research showing that racial disparities in outcomes all but disappear when comparing patients in equal access settings, such as the US Veteran’s Affairs health system.

A striking example of how people of color are treated differently in the health care system is their disproportionately low clinical trial representation. According to a recent ProPublica analysis, fewer than 5 percent of clinical trial participants in trials of cancer drugs approved since 2015 were black, despite making up 13.4 percent of the overall population. In no trials were African Americans the largest group represented, even for cancers that African Americans are at a greater risk. Asian Americans and Native Americans are similarly absent in these clinical trials.  

“[People of color] are potentially losing out on life-extending opportunities because it’s one more option they no longer have,” said Dr. Kashif Ali, research head at Maryland Oncology Hematology, in ProPublica. Participation in clinical trials often require significant time and financial resources to travel long distances, take time off work, and find childcare. And there isn’t enough pressure from the FDA on pharmaceutical companies for them to invest resources in making their trials more inclusive.

As Nadi and Trinh write, we need to abandon the idea of genetic differences driving racial disparities and work on providing access and high-quality health care to all. Even more importantly, we need to focus on the socioeconomic disparities that coincide with race and address racism that causes toxic stress and worse health outcomes for people of color.