FRONTLINE CANCER: Reducing the disparities in cancer care

Dr. Scott Lippman
Dr. Scott Lippman

By Scott M. Lippman, M.D.

Cancer is a worldwide scourge. Every year, there are more than 14 million new cases and 8 million deaths. Heart disease is still the biggest killer in the United States, but cancer is expected to eventually supersede it. Indeed, cancer is already the leading cause of death in San Diego County.

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Dr. Scott Lippman

And yet cancer — or rather the spectrum of diseases we collectively call cancer — is not uniform in its affliction. Different types affect different people differently. It’s obvious why women don’t get prostate cancer and breast cancer is comparatively rare among men. It’s less clear why some forms of brain cancer are more common in women or why tonsil and other forms of head and neck cancers are more prevalent among males.

Some reasons likely relate to differences in physiology and biology; others to cultural histories and social behaviors. And yet others to factors associated with poverty, low education and prejudice.

The last group of factors is arguably the most concerning because it is also the most tractable. Reducing cancer disparities is — or should be — as important and compelling as the overall drive to conquer cancer itself. It is part of the mission at the National Cancer Institute-designated UC San Diego Moores Cancer Center, one in which we have invested dedicated researchers, programs and funds.

These men and women are defining the challenge and marking a path to improvement. For example, a team of scientists recently looked at the impact of racial inequalities in the treatment of African-Americans for metastatic colorectal cancer. The team included principal investigator James D. Murphy, M.D., chief of the Gastrointestinal Tumor Service for Radiation Oncology at Moores and first author Daniel R. Simpson, M.D., in the Department of Radiation Medicine and Applied Sciences.

They found that African-Americans with metastatic colorectal cancer were measurably less likely to be seen by cancer specialists or receive advanced forms of treatment, resulting in a 15 percent higher mortality rate. Roughly 140,000 Americans are diagnosed annually with colorectal cancer, according to the American Cancer Society, and more than 50,000 will die this year. It’s the third leading cause of cancer death in the United States.

On the plus side, significant progress has been made in the prevention of colorectal cancer. On the negative, the benefits of screening and early detection have not been evenly distributed. Some populations, such as the uninsured, recent immigrants and some racial/ethnic minority groups, are particularly impacted. For example, the disease disproportionately affects black patients, who experience high incidence rates, more advanced stages at diagnosis and decreased survival rates compared to other ethnic groups.

In their study, published in the

Journal of the National Cancer Institute

, Murphy and colleagues found that black patients were 10 percent less likely to have primary tumor surgery, 17 percent less likely to receive chemotherapy and 30 percent less likely to receive radiotherapy. Among patients who got chemotherapy, they found white patients typically got it sooner and received more treatments than black patients. Timely chemotherapy reduces the risk of death from colorectal cancer more than 60 percent.

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