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Robert A. Winn, M.D., director and Lipman Chair in Oncology at VCU Massey Cancer Center, was a keynote speaker at the 5th Annual Meeting of the American Cancer Society National Lung Cancer Roundtable (NLCRT), held virtually December 6-7, 2021.

The NLCRT is a consortium of representatives from national societies, cancer centers, government agencies, advocacy and policy organizations, research groups and corporations. The more than 160 members work together to reduce lung cancer mortality.

The theme of the 2021 meeting was Disparities To Equity: Moving the Needle On Lung Cancer. To advance the conversation, Winn spoke about the effects an individual’s zip code (ZNA) has on cancer risks.

“We are really poised particularly around lung cancer to answer the big problem of building that interplay between ZNA and DNA,” said Winn.

Winn explained people of color (POC) are especially vulnerable to pollutants like particulate matter 2.5 because more of them live in and near industrial communities. According to Winn, companies historically built their factories in areas that were considered to be undesirable for habitation. However, redlining of the 1930’a and more recent urban renewal programs increased housing in these urban neighborhoods and rural towns.

“Stop with the, ‘It’s only our DNA,’ African Americans, and stop with the language that African Americans are more predisposed. To what? From a biological sense, I think it becomes a less strong argument that we are just biologically getting lung cancer as opposed to what structures were put in place that ultimately cause the additional stress,” said Winn. “We have the genetics.  Additional environmental things are also contributing.”

Winn stressed saving the lives of more POC depends on expanding cancer prevention, early detection and screening programs; developing more effective, lower cost treatments; focusing on survivorship and mental health; and recognizing the convergence of science.

“Not just what is happening on the level of the human cell,” Winn said. “What is the interaction with what’s outside of the cell? ZNA matters. Where you live, your place and space matters.”

Winn also called for greater attention to closing broadband gaps to allow for increased telehealth opportunities. While Winn said diversifying clinical trials is paramount, he acknowledged that making them more pragmatic and accessible will boost enrollment and further science. He emphasized that a community’s level of trust in health care providers has been missing for far too long in the disparities conversation.

“At the end of the day, what COVID has taught me is that all the miracles of science don’t mean anything if people don’t trust you,” Winn said. “Why aren’t we developing a trustworthiness scale for institutions?  Why do we assume as institutions we’re going to do these things for what and for how long?  Being in a community for a period of a grant is the best way to build distrust as opposed to building trust.”

Winn concluded that transportation is keeping many people from receiving the care they need, and he challenged health systems to move beyond voucher programs for patients who travel great distances to access screenings and treatments.

“We need people who care, who care that people who can’t get to us have to still get the quality programs,” Winn said. “How do we become real partners in the fight to reduce lung cancer in all populations?”

The NLCRT convenes annually to engage in research and projects that no one organization can take on alone. It is the NLCRT’s belief that working collectively and collaboratively will drive progress faster to create lung cancer survivorship.

Written by: Amy Lacey