Improving Societal Factors Can Lead to Reduction of Racial Disparities in Cancer Outcomes
Mary Nittala, DrPH
By Stephanie Markovina, MD, PhD
Disparities in cancer outcomes have been attributed to race in the setting of many cancer subtypes, often with poorer outcomes among racial minorities of the U.S. population. Historically, some argued that poor cancer outcomes in these populations result from adverse tumor biology. While it is possible that genetic traits associated with race may predispose to more aggressive cancers, it is increasingly clear that structural racism and the myriad downstream effects have a profound effect on cancer outcomes, in particular for Black Americans. In their work presented at the 2020 ASTRO Annual meeting, Mary Nittala, DrPH, and colleagues addressed the complex interplay between structural, socioeconomic, socio-environmental, behavioral and biologic factors to understand whether African-American (AA) patients with cervical cancer have different overall survival (OS) and local control (LC) following definitive chemoradiation therapy (CRT) compared to Caucasian (C) patients on the basis of race.
The authors found that OS and LC were not statistically different between the AA and C cohorts. Within the limitations of retrospective analysis, the authors evaluated multiple factors including disease stage, insurance type, body mass index (BMI) and smoking history in addition to ethnicity, which was self-reported in this study. Interestingly, multivariate Cox regression analysis suggested that the impact of race on OS was much weaker than insurance, BMI and smoking history. Importantly, treatment duration was also a controlled variable. One unique aspect of the cohort in this study is that AA patients accounted for the majority compared to C patients.
“The causes of racial disparities in cancer outcomes are multifactorial. Our paper suggests that improving societal factors can lead to more immediate beneficial results as we continue to research on biological factors,” explained Dr. Nittala. With respect to their future directions, she stated, “We will continue to research on cancer outcome disparities in not only cervical cancer, but also other disease sites.” The authors’ findings are perhaps not surprising, as similar insight has been provided before. In a 1991 manuscript entitled “Cancer prognosis in black Americans: a mini-review,” Robert E. Hardy and Margaret K. Hargreaves discussed the gap in understanding of how unmeasured but related variables contribute to “race” effects in cancer outcomes. They concluded, “A more comprehensive plan based on providing opportunities for upward mobility is likely to be the ultimate solution, but this will require national governmental commitment, which is not presently evident.”
Survival and Local Control among African-Americans and Caucasians following Treatment of Cervix Cancer in a University Medical Center was presented on Saturday, October 24, as part of Poster Viewing (PV) 01.
Published on: October 25, 2020