‘Awareness Is Not Enough’ to Eliminate Racial Cancer Disparities

WASHINGTON—Knowledge, research, and education alone will not end the cancer disparities among American populations, said numerous speakers at the opening session of the 8th Biennial Symposium on Minorities, the Medically Underserved, and Cancer, presented by the Intercultural Cancer Council (ICC) and jointly sponsored by Baylor College of Medicine, Houston.

In keeping with the symposium’s official theme, "Awareness is not enough," Claude Allen, JD, ML, deputy secretary of the Department of Health and Human Services (HHS), declared the "elimination of all health disparities" to be an important commitment of HHS. Although US life expectancy at birth has hit an all-time high of 76.9 years, black life expectancy continues to lag behind that of whites by about 5 years.

Various minority groups, he added, bear heavier burdens of various cancers than whites. Blacks, for example, have high rates of a number of cancers including prostate. Hispanic women, meanwhile, have the highest rates of cervical cancer, and Asian and Pacific Islanders have the highest rates of liver and stomach cancers.

HHS will "mobilize public and private resources" in several areas of public health, including cancer screening and management, he promised. Education is particularly crucial; blacks often "delay doctor visits as long as possible," he said, and fail to follow prescribed regimens when they do go. In an effort to change these behavior patterns, HHS is partnering with media outlets such as ABC radio to convey the importance of regular checkups in a form that will appeal to black audiences.

Mr. Allen also described the 5-year plan for research on health disparities being developed by NIH. President Bush, he added, is committed to doubling the number of community health centers.

New Center on Minority Health

An important step toward eliminating inequities was taken in January 2001, when the Office of Minority Health at the National Institutes of Health (NIH) became the National Center on Minority Health and Health Disparities, said the Center’s director, John Ruffin, PhD.

The new entity, which, unlike the old office, has the power to make grants, focuses on underserved populations "wherever they are," he said. It also coordinates the health disparity agenda for all of NIH. A strategic plan, over a year in the making, will be handed in shortly, Dr. Ruffin said. If, despite input from a wide range of groups, the plan still has deficiencies, they will be corrected during annual reviews, he added.

One of the new center’s important initiatives is a loan repayment program for young scientists and physicians interested in doing research on minority health and health disparities, Dr. Ruffin said.

The "carrot" of up to $35,000 of loan repayment a year will, he predicted, help produce the strong workforce needed to make progress. The Center has already made 50 such awards, he said.

In addition, Dr. Ruffin favors the development of the first NIH endowment program to strengthen infrastructure at institutions that "do good science but have small endowments." To help institutions win grants, the Center sponsors programs offering technical assistance in writing applications.

The HHS’ Health Resources Services Administration (HRSA), the federal government’s "access agency," is also working on eliminating racial and ethnic disparities in cancer, said Betty Dukes, PhD, the agency’s acting administrator. The 320 community health centers that the agency currently supports, and which serve 11 million people a year, will increase to 1,200 within 5 years, and the number of patients will double, she said.

President Bush is "determined to use HRSA to get more health care to people who need it," she said. One mark of their success is that more than 80% of female community health center patients are currently up to date on their Pap smears and 63% are up to date on their mammograms—rates that exceed those of the general population, she said.

The HRSA is also working on several cancer initiatives, including piloting a cancer collaborative among 10 health centers designed to improve treatment and engage patients in self-management. It is also supporting telehealth programs for cancer that provide telephone consultations and distance learning.

Work at the CDC

The same realization that "awareness is not enough" to eliminate the unequal burden of cancer also guides work at the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC), said the division’s director, Nancy Lee, MD.

More work is needed to track the rates of rare cancers in minority groups, Ms. Lee said, noting that cancer registries have improved markedly over the past 5 years and that there has been a "dramatic improvement" in the number of state registries certified as high quality.

These registries now cover three quarters of the American population, and the CDC has recently commissioned the first-ever monograph on ovarian cancer in racial and ethnic groups.

In addition, evidence-based reviews of community-based interventions are now underway. The American Indian Initiative, for example, targets a traditionally hard-to-reach group with $6 million devoted to breast and cervical cancer services by tribal-based entities. A large qualitative research project is currently evaluating the project’s effectiveness and will make recommendations on successful strategies available to both other tribes and the CDC.

Those strategies, which include developing effective communication, building trust, and taking advantage of technical assistance, are applicable far beyond tribal communities she said, adding that the projects she described give only a "flavor" of the work on minority and under-served communities now underway at the CDC.

Fastest Growing Populations

Despite all the efforts outlined, more action is still needed to eradicate cancer among America’s "fastest growing populations," the racial and ethnic minorities, said Susan M. Shinagawa, immediate past chair of the ICC, community director of the Asian American Network for Cancer Awareness, and founder and co-coordinator of the Asian and Pacific Islander National Cancer Survivor Network, Silver Spring, Maryland. What is already known could, if applied, reduce cancer incidence and death, she said.

New Cancer Bill

The program’s final speaker, Senator Dianne Feinstein, Democrat of California, asked the assembled ICC members for active support for the Cancer Bill of 2002. She began her video address by expressing regret that congressional business prevented her personal attendance at the symposium.

"We need a new battle plan against cancer," she said, noting that a national plan was last drawn up in 1971. The proposed bill would increase NCI’s appropriation to allow funding of 40% of research grants instead of the current 28%, and also provide funds for training more researchers and oncology nurses and increasing treatment among racial and ethnic minorities.

"I need your help," Ms. Feinstein said. "Unless the cancer community weighs in, we are not going to get this bill passed.