The United States could significantly reduce the incidence of cancer in the years ahead without any further research breakthroughs -- if all available information about cancer prevention, detection, early treatment, intervention and education were put to use now, cancer researchers and minority health officials meeting in Washington said yesterday.
Speaking at the Intercultural Cancer Council's (ICC) 8th Biennial Symposium on Minorities, the Medically Underserved, & Cancer, cancer control experts told the over 1,000 conference attendees that just making use of the information that now exists will significantly improve the survival of all Americans who are poor, lack health insurance, or otherwise have inadequate access to quality cancer treatment. The ICC Symposium is the only national conference that focuses specifically on the treatment of cancer among the nation's minority populations.
When it comes to improved outcomes, Armin Weinberg, PhD, director of the Chronic Disease Prevention and Control Research Center at Baylor College of Medicine (Houston) and co-founder of the ICC, noted that increasing access to existing cancer prevention and control strategies could result in a 25 percent drop in incidence and a reduction of 50 percent in cancer deaths among the medically underserved. ``As these special populations continue to grow at a rapid rate, they will as a whole become the 'majority' population of our nation,'' said Dr. Weinberg. ``That's why an intensified focus on translating what we already know about cancer prevention and control must become a new imperative of the public health community.''
To underscore why an intensified effort is so significant, Dr. Weinberg and his colleagues presented the latest statistics about how cancer impacts minorities and the poor. Some of these findings include:
* African Americans have higher likelihood of developing and dying from cancer than persons of any other racial or ethnic group. During 1992- 1998, the average annual incidence rate for all cancers was 445.3 per 100,000 blacks as opposed to 401.4 per 100,000 for whites.
* When it comes to prostate cancer, African American males are much more likely to develop the disease (234.2 cases per 100,000, compared to 144.6/100,000 among white men) and die from prostate cancer at more than twice the rate of white men (53.1/100,000 compared to 22.4/100,000).
* Among Mexican American and Puerto Rican women, cervical cancer incidence is two to three times higher than in non-Hispanic white women.
* Hispanics experienced the highest invasive cervical cancer incidence rates (16.2 per 100,000) of any group other than Vietnamese, and twice the incidence rates of non-Hispanic White women (7.9 per 100,000).
* Cancer is the second leading cause of death among American Indians and Alaska Natives over the age of 45.
* Cancer is the leading cause of death for female Asian Americans. In fact, Asian American females are the first American population to experience cancer as the leading cause of death.
Compounding these statistics, experts at the Symposium identified the lack of physician understanding about how cancer impacts specific ethnic populations as a major problem. Linking this lack of awareness to a delayed diagnosis of cancer in certain at-risk populations, Susan M. Shinagawa, founder and coordinator of the Asian & Pacific Island National Cancer Survivors Network, relayed how her surgeon mistakenly ruled out a cancer diagnosis because of her young age and Asian ancestry. Only much later, after a mastectomy and chemotherapy, did Shinagawa herself learn the truth: women in Asia are less likely to get breast cancer than American women, but granddaughters of Asian immigrants in the US have a cancer rate approaching that of whites.
Beyond early diagnosis and access to state-of-the-art treatment, the Symposium also addressed the persistent disparity in quality of life cancer care for minority patients and the poor. According to Richard Payne, chief of the Pain and Palliative Care Services of Memorial Sloan Kettering Cancer Center (New York), while lack of appropriate pain management and palliative care affects all population groups, the problem is especially acute among minority populations. Reporting on a number of inner-city programs that educate patients and families about palliative care options, he said: ``We need to improve the treatment of pain patients receive. But we also need to ensure that cancer patients get the emotional and spiritual care as part of the overall management of their disease. Many people are under-treated.''
When it comes to providing end of life care for the medically underserved, Judith Kaur, MD, principal investigator of the Mayo Clinic's American Indian/Alaska Native Initiative on Cancer, said that many minority cancer patients die without getting proper support and management of their symptoms. ``End of life is a special time for families and care givers, and we need to be able to offer better care to people of color and populations in underserved areas. This is especially true for people who don't speak English and may need interpreters and publications that address their needs.''
``Awareness of the problem is not enough,'' says Lovell A. Jones, PhD, professor and director of experimental gynecology and director of the Center for Research on Minority Health at MD Anderson Cancer Center (Houston). ``We need to move from just acknowledging problems of underserved communities to doing something about it.''
But not all disparities in the treatment of cancer are due to lack of access. One such issue is the significant toll tobacco takes in communities of color here and abroad. In the US, tobacco use is responsible for nearly one in five deaths. The American Cancer Society estimates that 47 million US adults are current smokers with cigarette smoking being highest among American Indians and Alaska Natives (41 percent).
``There is a growing cancer epidemic is some countries in Asia and the Middle East that threatens to dwarf AIDS and dramatically add to the burden of disease among minority groups in the US,'' said Dileep G. Bal, MD, MPH, chief of the Cancer Control Branch of the California Department of Health Service. ``This is a completely preventable epidemic that is being fueled by a relentless, commercially-based campaign to encourage tobacco use among these populations.'' Accordingly, Bal has organized an Anti-Tobacco Day at the Symposium where he and his colleagues will promote new strategies to counteract the tobacco industry's ``predatory marketing'' in minority communities, such as ethnic advertising and the industry's sponsorship of cultural and ethnic events.
Sponsored every two years by the Intercultural Cancer Council to address the prevention and treatment of cancer among the medically underserved, the 2002 Symposium brings together a who's who of cancer experts and policy makers, including Andrew von Eschenbach, MD, the new direct or of the National Cancer Institute; James W. Hampton, MD, FACP, medical director of the University of Oklahoma and chair of ICC; John Ruffin, PhD, National Center for Research on Minorities and Health Disparities (NIH); Betty Duke, PhD, acting administrator of the Health Resources and Services Administration (HRSA); and Nancy Lee, MD, director, Division of Cancer Prevention and Control (CDC).
Based in Houston, Texas, the Intercultural Cancer Council (ICC) is the leading non-profit organization working to eliminate the unequal burden of cancer among ethnic minorities and medically underserved populations in the United States and its associated territories.