Deadly Consequences: Inequities in Cancer Screening
In the past year, we’ve seen a national reckoning on race that has forced us to examine the systemic racism that exists in our society and the challenges that people of color face. Though some progress has been made, healthcare is one area that continues to be plagued by inequalities. Too often, a person’s access to quality healthcare is determined by their ethnicity, age, income or where they live. When it comes to getting people the care they need, when they need it, we have a lot of work to do.
Disparities in cancer care can be found along each step of the patient’s journey — starting with screening and diagnosis all the way through treatment and outcomes. According to one study, 34% of cancer deaths among Americans aged 25–74 years could be avoided if socioeconomic disparities, such as income, education level, and occupation, were eliminated. In fact, Black people have the highest death rate and shortest survival of any racial/ethnic group for most cancers in the U.S. Black men also have the highest cancer incidence. The Latinx community in the U.S. is also severely impacted by disparities in cancer care, driven by limited access to healthcare services. For example, research shows that Latinx people are less likely to have health insurance and a regular healthcare provider than White people, which prevents them from accessing preventative services, cancer treatment and follow-up care. The playing field is nowhere close to being equal.
The disparities that hinder early cancer detection are particularly alarming; research shows that detecting cancer at its early stages, before it has a chance to spread, is critical to overall survival rate. On average, Black people are more likely to be diagnosed with cancer at a later stage than White people, and what’s more, Black people are more likely to be diagnosed with cancers that don’t currently have screening guidelines. Without screening guidelines, people are less likely to be screened or diagnosed with certain types of cancer. These inequities could have life and death consequences — and it is on the cancer community to fix this.
A Closer Look
The United States Preventive Services Task Force (USPSTF) is responsible for providing recommendations about the effectiveness of preventative care services for people without obvious related signs or symptoms via a rating system. The USPSTF recommends screening for breast, cervical, colorectal (colon), and lung cancers; however, these recommendations exclude some cancers that Black, Hispanic, or American Indian/Alaska Native people are more likely to be diagnosed with, and at a later stage, such as prostate cancer.
Prostate-specific antigen (PSA) testing came under scrutiny in 2012, when the USPSTF concluded that the potential benefits of screening for prostate cancer do not outweigh potential harms and gave PSA testing a D recommendation. Because of this rating, PSA testing was rarely conducted, which was particularly dangerous for high-risk populations including Black men who face higher incidence and death rates compared to White men.
There are often no symptoms of prostate cancer until it reaches a late stage, but at this point, people living with this type of cancer have only a 30-percent five-year survival rate. In 2018, progress was made when the USPSTF updated the PSA testing recommendation to a C, but barriers still exist and Black men today are 2.2 to 2.5 times more likely to die from prostate cancer as compared to any other racial group.
Even for cancers with recommended screening guidelines, there’s concerning evidence that shows minorities are not being screened, or they’re not being screened with the most advanced technology. According to recent studies published in the Journal of the American College of Radiology and JAMA Network Open, Black women were more likely to be screened with 2D mammograms than White women. However, 3D mammography has been shown to be more reliable in terms of detection of breast cancer and generating fewer false positives — while patients may not know the difference in the technology, healthcare providers do. Similarly, it was recently reported that there is less biomarker testing among Black people with non-small cell lung cancer (NSCLC) compared to White people. If doctors don’t know whether they should be targeting a mutation, people with NSCLC won’t receive targeted therapies they need.
Closing the Disparities Gap
Because of inequities people face in the healthcare system due to their race, socioeconomic status, access to insurance coverage among other barriers, the best screening and treatment options aren’t always made available to patients. At Pfizer, we’re seeking to address these inequities in a multitude of ways.
We are actively partnering with the global cancer community to drive a dialogue that can help raise awareness of different types of cancer, increase education for patients and caregivers when faced with a diagnosis, and improve access to needed diagnostic testing and treatments. In 2020, we worked with advocacy organizations to help pass legislation in the state of Maryland that requires health insurers to cover the full cost of prostate cancer screenings for men between 40 and 75, making these tests more accessible. This year, we also helped to progress legislation in Illinois that will expand coverage of biomarker testing for state regulated public and private insurance plans, an important step to increasing access to precision medicines that can lead to improved survivorship and better quality of life for patients.
Earlier this year, the American Cancer Society and Pfizer Global Medical Grants launched community grants focused on addressing prostate cancer disparities impacting Black men, and last year, The Pfizer Foundation awarded 10 $250,000 grants through the Social Determinants of Health Grant (SDOH) program. This program supports organizations that address leading causes of mortality and morbidity in Black communities in the U.S. by working to strengthen health systems. Of the 10 grant recipients, three organizations have goals directly tied to advancing equitable cancer screening in underserved populations.
During the COVID-19 pandemic, there has been a stark decrease in the number of cancer screenings and follow-up appointments, which could undo years of progress made in lowering cancer death rates. To address this, we developed programs in the U.S. and Brazil to encourage people to keep screenings and follow-up appointments on their calendars where it was safe to do so, and created resources to help people understand how to prepare for these appointments. In Europe, we sponsored the European Cancer Organisation’s (ECCO) ‘Time to Act’ campaign, which shared materials through its Covid-19 & Cancer Hub to support residents during COVID-19 and provide resources to continue their cancer treatment or keep their screening appointments. The Time to Act resources were also translated into more than 30 languages, making them accessible to people across the continent.
Making screening and preventive care more equitable is a non-negotiable in the fight to end healthcare disparities and create a system that works for all people. Biopharmaceutical companies, healthcare providers, advocacy organizations and policymakers must continue to work together on solutions to reduce disparities and advocate for underrepresented communities — people’s lives depend on it.
