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Cancer survivors, advocates, congressional representatives, and other supporters packed a briefing room at the Rayburn House Office Building on Capitol Hill on May 15 to learn about cancer equity advances made in recent years.

Robert A. Winn, M.D., director and Lipman Chair in Oncology at VCU Massey Comprehensive Cancer Center, led a Congressional briefing on the American Association for Cancer Research (AACR) Cancer Disparities Progress Report 2024.

Winn, who served as chair of the report steering committee, recognized that advances in prevention, early detection and treatment allowed the overall cancer death rate in the U.S. to fall by 33% between 1991 and 2020. However, advances have not benefited everyone equally.

"This is a report about power and progress,” said Winn at the beginning of the briefing. “The findings of this report offer a deeper dive into the ‘whole person’ as it relates to the areas outside of medicine that contribute to health inequities: ZNA (ZIP code and neighborhood of association), institutional and systemic racism, and situational and physical barriers to access, to name a few.”

According to the AACR Cancer Disparities Progress Report 2024:

• Although the overall cancer incidence rates among Black and Indigenous populations are lower compared to the white population, Black and Indigenous individuals have the highest overall cancer death rates of all U.S. racial or ethnic groups. This disparity is particularly striking with regards to the Black community:
  • Black men are twice as likely to die from prostate cancer compared to white men.
  • Even though the incidence of breast cancer is similar in Black and white women, Black women have a 40% higher likelihood of dying from it.
  • Black individuals are twice as likely to be diagnosed with and die from multiple myeloma.
• American Indian or Alaska Native, Asian and Pacific Islander, and Hispanic people are more than twice as likely to die from stomach cancer compared to white people. These groups also experience higher incidence and mortality rates for liver cancer.
• Lung cancer incidence is rising among Asian women who have never smoked.
• ZIP code matters: According to the most recent data, residents of nonmetropolitan or rural counties were 38% more likely to be diagnosed with and die from lung cancer, compared to those living in large metropolitan or urban areas.
• Sexual and gender minorities also experience notable disparities:
  • Risk of breast cancer is higher among sexual minority women compared to heterosexual women.
  • Transgender individuals are at a 76% higher risk of being diagnosed with advanced-stage lung cancer compared to cisgender individuals.
  • While transgender women appear to be at a 60% lower risk of developing prostate cancer compared to cisgender men, their likelihood of dying from it is nearly double.

Katherine Y. Tossas, Ph.D., M.S., director of the Office of Catchment Area Data Analytics at Massey, served as a co-author and member of the report’s steering committee, along with Nolan Wages, Ph.D., director of the Biostatistics Shared Resource at Massey.

At the Congressional briefing, Tossas sat on the panel to represent junior faculty.

“We all have perspectives that are valued and valuable,” Tossas said about the importance of including early career researchers in efforts to address disparities.

AACR Cancer Disparities Progress Report 2024 identified racism, segregation and discrimination against marginalized population groups as the cause for structural inequities and systemic injustices that negatively impact human health and limit opportunities for higher education among underrepresented individuals, which contributes to the lack of diversity in the cancer research and care workforce.

“We focus on training the next generation of cancer researchers from all populations. We’ve been doing this for quite some time,” said Sanya A. Springfield, Ph.D., director of the National Cancer Institute’s (NCI) Center to Reduce Cancer Health Disparities, who has worked on all three reports to date. “We made progress, but I think one of the things that we need to do more of is increase diversity in the workforce.”

Additionally, the report explored the roots of the inequities and the many complex and interrelated reasons why they persist. They include social drivers of health like education level, income, employment, housing, transportation and access to healthy food, clean air, water and health care services; ancestry-related biological factors, including differences in genetic variants, epigenetic alterations, immune profiles and microbiomes; the lack of diversity in existing cancer genomics datasets; the lack of diversity in the Science, Technology, Engineering, Mathematics and Medicine (STEMM) educational and career pathways; and the underrepresentation of minority groups in clinical trials.

“We are seeing the face of cancer change,” said Marcia Cruz-Correa, M.D., Ph.D., chief medical officer at the University of Puerto Rico Comprehensive Cancer Center (UPRCCC), about lives that she has seen saved by enrolling a more diverse patient population in clinical trials.

UPRCCC and Massey partner for the post-doctoral BRIDGE fellowship focusing on Latino health. It is just one initiative nationally that aims to reduce disparities and achieve health equity for all patients.

AACR Cancer Disparities Progress Report 2024 also highlighted:

• Several efforts to collect diverse datasets are underway, including the AACR Project Genomics Evidence Neoplasia Information Exchange® (AACR Project GENIE®), African Cancer Genome Registry, Avanzando Caminos (Leading Pathways) Study, Black Women’s Health Study (BWHS), Multiethnic Cohort Study, Southern Community Cohort Study, and Women’s Circle of Health Study.
• Intentional engagement strategies and population health navigation programs have demonstrated success in improving representation in clinical trials.
  • One study found that culturally tailored messaging as well as partnerships with trusted community outreach organizations and patient advocacy groups led to 11% more Black men enrolled in prostate cancer clinical trials.
  • Another study found that a navigation program addressing common barriers to cancer care for medically underserved populations — including food, clothing, housing, transportation, language, health literacy and social support —increased participation in clinical research among rural, Black and Hispanic patients.
• Many programs and pathways have been established to promote diversity in STEMM, including initiatives led by the American Indian Science and Engineering Society (AISES), the Asian American and Native American Pacific Islander-Serving Institutions Program, the National Action Council for Minorities in Engineering (NACME), the Society for the Advancement of Chicanos/Hispanics and Native Americans in Science (SACNAS), and the United Negro College Fund (UNCF), among others.
• Within the NCI, the Center to Reduce Cancer Health Disparities is leading numerous initiatives to train students, researchers and clinician-scientists from underrepresented communities in cancer and cancer disparities research, thereby increasing diversity across the academic cancer research continuum.

“We are very proud to release the third edition of the AACR Cancer Disparities Progress Report,” said Margaret Foti, Ph.D., M.D. (hc), chief executive officer of AACR. “In this era of extraordinary scientific progress against cancer, it is crucial that we ensure that no populations or communities are left behind. Health equity is a fundamental human right and must be a national priority. We hope that the information and recommendations in this report will inspire collaboration among stakeholders and the necessary support from Congress to tackle these complex issues and eliminate cancer disparities once and for all.”

First published in 2020, this biennial report raises awareness of the enormous toll that cancer exacts on racial and ethnic minority groups and other medically underserved populations in the United States. This year’s report includes nine compelling personal stories from cancer survivors of various backgrounds. These stories underscore the vital importance of funding meritorious cancer research and enacting legislation to achieve health equity, which is a fundamental human right.

Winn ended the Congressional briefing with a call to action; he asked Congress to provide funding increases for agencies and programs tasked with reducing disparities:

• Congress should appropriate at least $51.3 billion for the NIH in fiscal year 2025
• Congress should appropriate at least $7.9 billion for the NCI in fiscal year 2025
• Congress should appropriate $472.4 million for Centers for Disease Control Division of Cancer Prevention and Control\
• Congress should robustly support the Environmental Protection Agency’s Cancer Moonshot Activities, including the Office of Environmental Justice and External Civil Rights

Winn said AACR Cancer Disparities Progress Report 2024 offers solutions that will allow even more progress to be made in the coming years.

“As we continue to look at cancer incidences and outcomes and cross check them against these other factors, while having critical conversations that spur meaningful action within our affected communities, our path forward will become clearer,” Winn commented. “We have seen tremendous progress against cancer in the last few decades, but we must keep fighting to ensure equal access and improved health care delivery for all people. The key is to keep talking, reporting and advocating."

Written by: Amy Lacey

A portion of this article first appeared in a news release and was used with permission by the AACR.