Adapted from the National Cancer Institute; Chart: Naema Ahmed/Axios 

There's some good news in 2020: Cancer death rates have been falling overall, and the gap between racial and ethnic groups has been narrowing.

Yes, but: Decades of systemic racism and the structures developed under it continue to limit the ability of Americans to benefit equally from cancer advances, some medical experts tell Axios, as seen by Black Americans who've had the highest death rate from cancer for 40 years. And the pandemic is expected to exacerbate the problem further.

"When we talk about even the folks who are caring for those underserved groups — the numbers of researchers and of doctors — there are disparities there. When we talk about funding, most of our underserved patients get their care at under-resourced places. It's a continuum, and it's all because there were structures [based on systemic racism] set up long ago."
— Loretta Erhunmwunsee, a City of Hope thoracic surgeon, tells Axios

Driving the news: The American Association for Cancer Research on Wednesday issued its first annual cancer disparities progress report intended to be a "baseline" for watching trends, says John Carpten, chair of the report's steering committee and of the AACR Minorities in Cancer Research Council.

  • "Socioeconomic issues, financial toxicities and health care inequities in general are definitely the foundation of many of the disparities that we know exist," Carpten tells Axios.
  • "And, without dealing with and addressing and mitigating those issues, no matter what we do to improve our understanding of cancer, all of that will be moot."

The good news: Overall cancer death rates dropped for all groups from 2000 to 2017...

  • 30% for African Americans.
  • 20% for white people, Hispanics and Asians/Pacific Islanders.
  • 11% for American Indians/Alaska Natives.

The bad news: The report says cancer burden disparities are evident in many areas, like...

  • African American men and women face a greater risk of dying from prostate cancer (111%) and breast cancer (39%), respectively, compared to their white counterparts.
  • Hispanic youths are more likely to develop leukemia than white youths, with a 20% higher risk for Hispanic children and a 38% higher risk for Hispanic adolescents.
  • Asian/Pacific Islander adults are twice as likely to die from stomach cancer than white adults.
  • Poor men have a 35% higher death rate for colorectal cancer than wealthy men.
  • Bisexual women are 70% more likely to be diagnosed with cancer than heterosexual woman.

Lack of diversity in both the health care workforce and in clinical trials is also a problem.

  • "Less than 11% of researchers in the U.S. are members of underrepresented groups," says Antoni Ribas, president of AACR, who spoke Wednesday at a congressional briefing on the report.
  • "AACR is also extremely concerned that racial and ethnic minorities continue to be underrepresented in cancer research and clinical trials, especially because the different ages, races and ethnicities may respond differently to cancer treatments," Ribas says.

Between the lines: Further research is needed to better understand the importance of any biological or genetic differences, says Namandjé Bumpus, professor and chair of the pharmacology department at Johns Hopkins University School of Medicine.

  • "There's this promise of precision medicine, but we don't even have the data or information to be able to leverage precision medicine for a lot of people," Bumpus tells Axios.
  • "Cancer really is a prime space for precision medicine. Both in the context of figuring out what works best for certain tumors and tumor types and people because of the genetics of their cancer, but also because of the flip side, the genetics of their drug response," she says.
  • Carpten, who is also professor and a department chair at USC Keck School of Medicine, agrees and says research has started to grow as technology advances and interest has been sparked.
  • "We're starting to see molecular differences in the characteristics of cancers from individuals of different degrees of genetic ancestry ... and these differences have been observed in diseases like prostate cancer, breast cancer, multiple myeloma, and colon and colorectal cancers," he adds.
  • Some initiatives on this include the AACR's Project GENIE and the NCI-funded AMBER Consortium, which studies breast cancer in African American women.

What's next: Ribas says AACR has formed a task force to call on policymakers and stakeholders to work on concrete actions to alleviate cancer disparities.

Go deeper: The cost of racial disparities in clinical trials

Go deeper

Updated Oct 7, 2020 - Axios Events

Watch: Solving for health equities

On Wednesday, October 7, Axios' Caitlin Owens hosted a conversation on how the pandemic has worsened social and racial inequities in the American health care system, featuring Rep. Markwayne Mullin (R-Okla.) and Rep. Raul Ruiz (D-Calif.).

Rep. Markwayne Mullin discussed disparities in healthcare for Native Americans, who largely rely on Indian Health Service hospitals for care. Mullin, who is Cherokee, noted that Native Americans have been disproportionately hit with COVID-19.

  • On the need for health data sharing between the federal government and the Indian Health Service: The IHS should have the same access to data as states. Without it, we’re essentially running blind and not able to learn and improve how we treat COVID-19.
  • On steps Congress can take to fix these health disparities:
    • Data sharing
    • Expand telemedicine care, especially for rural communities
    • Expand education
    • Get IHS fully funded
  • Read more: Indian Health Service fights coronavirus with fewer services

Rep. Raul Ruiz unpacked the pandemic’s disproportionate impact on essential workers, like Latino farm workers, who have high occupational risk hazards and few workplace protections.

Axios Co-founder and CEO Jim VandeHei hosted a View from the Top segment with Humana Chief Medical and Corporate Affairs Officer Dr. William H. Shrank who discussed Humana’s approach to health care, most notably their value-based care outcomes.

  • On the importance of social context when understanding health care outcomes: “We have a long history of partnering deeply in communities and trying to address social context needs, whether it’s social isolation, housing problems, food insecurity...we are focusing on reducing those disparities and promoting equity.”
  • On value-based care outcomes: The approach is to realign the way in which we pay our providers so that we reward them for delivering the outcomes that patients want...for taking care of people upfront and keeping them as healthy as possible.

Thank you Humana for sponsoring this event.

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Politics: McConnell urges White House not to strike stimulus deal before election — Republican senators defend Fauci as Trump escalates attacks.
  2. Health: The next wave is gaining steam.
  3. Education: Schools haven't become hotspots — University of Michigan students ordered to shelter-in-place.
Updated 2 hours ago - Politics & Policy

Biden has huge cash advantage over Trump as Election Day nears

Democratic presidential nominee Joe Biden in Wilmington, Delaware, on Monday. Photo: Drew Angerer/Getty Images

Democratic presidential nominee Joe Biden had $177.3 million in the bank at the end of September, per the latest Federal Election Commission filings.

Why it matters: President Trump's re-election campaign reported having $63.1 million in the bank at the end of last month, as campaigning enters the final stretch ahead of Election Day on Nov. 3.

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