World Cancer Day: Addressing disparities in cancer rates, deaths essential

For 2023, the World Cancer Day theme is “Close the Care Gap,” as while overall rates of the disease are declining, disparities in related deaths and care continue.

This is the second consecutive year that World Cancer Day is looking at inequities in cancer treatment, with barriers such as insurance coverage, ability to leave work, location and discrimination or biases based on gender, education level, race, ethnicity, sexual orientation, age or disability.

Cancer is currently the second leading cause of death in the U.S. — preceded by heart disease — though over the past three decades, diagnosis have dropped around 33%. Earlier detection, increased screening and more awareness have helped lower instances of the disease.

“It is great news for people who are in the cancer community,” says Dr. Folakemi Odedina, deputy director of community outreach for Mayo Clinic’s Comprehensive Cancer Center. “Whether you are a scientist or a clinician, or a survivor, or a patient, or even an advocate, knowing that some of the work that we are doing is really making an impact is great, and a result of the collaboration of many. But we are not where we want to be.”

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The CDC reported over 602,000 cancer deaths in 2020, and for 2023, Cancer.org predicts 1.9 million new cases and some 610,000 fatalities. 

Among Black or African American individuals, overall cancer death rates are higher than any other race, says Dr. Samantha Somwaru, family medicine physician at Mayo Clinic Health System in Barron. Black women are 40% more likely to die from breast cancer than white women, and Black men have twice the prostate cancer death rate. 

According to the American Cancer Society, across all cancer types Black men have 6% higher incidence and 19% higher mortality than white men, and while Black women have an 8% lower cancer incidence than white women, their mortality rate is 12% higher.

Black persons are also at higher risk of developing heart disease, diabetes, stroke and obesity.  

“Health disparities and health inequities are not new,” says Somwaru. “They have been documented for decades and reflect discrimination and racism.”

Social determinants of health — conditions in which people are born, grow, live, work and age — play a large role in health disparities. Examples include socioeconomic status, education level, neighborhood and physical environment, employment status, social support networks and access to health care.

Black individuals are three times more likely to experience hunger than white individuals, with 20% living in food insecure households. They are also more likely to live in areas considered food deserts, where fresh, healthy food is either difficult to acquire or too expensive to purchase, and poor diet increasing risk of health conditions.

Difficulty traveling to appointments, securing child care or time off work to see a physician or limited to no insurance coverage can lead individuals to skip preventative care and exams.

“As a family physician, I come across many people who don’t utilize preventive screenings for various reasons, but some of them truly have barriers to getting good care,” says Somwaru. “…The reason why preventive screenings are so important is that they find health conditions before the person develops symptoms. Early detection saves lives.”

Mammograms are recommended on an annual basis beginning at age 40, or earlier if the individual has a family history or other factors increasing risk. Cervical cancer screenings, including a Pap smear and HPV testing, are recommended every three to five years for those 21 and older, with those ages 11 to 26 advised to receive the HPV vaccine. 

Colon cancer screening should generally start at age 45, with colonoscopies to occur every decade or more frequently if predisposed to the disease. Lung cancer screenings should be performed on those 50 and older who currently smoke or who previously smoked heavily.

Patients are encouraged to bring up family history and any symptoms or pains during appointments, and to ask questions. Virtual care options may be available to help alleviate travel barriers, and individuals may qualify for free or reduced cost screenings at sites such as St. Clare Health Mission and Gundersen St. Joseph’s.

“As a physician, it’s my job to take care of every person that comes into the clinic,” says Somwaru. “Yet, I understand the importance of recognizing and addressing health disparities that place my African American patients at an increased risk.”

The Mayo Clinic Comprehensive Cancer Center, Odedina says, is working to address cancer disparities through community collaborations and partnerships, research and having more diversity in clinical trials.

“We need to focus on increasing diversity in research for all cancers so we can address why some are still rising and why others are decreasing,” Odedina says.

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