Brinker, Frederick: Disparities in cancer deaths reveal social inequities

Published in Modern Healthcare Magazine

March 20, 2023

The Centers for Disease Control and Prevention recently announced that U.S. life expectancy dropped for the second consecutive year in 2021, to 76.4 years from 77 the prior year. The change was largely driven by COVID-19 and drug overdoses, but cancer remains the second-leading cause of death.

According to the American Cancer Society, 2020 saw 9.4 million missed cancer screenings in the United States. In the early months of the pandemic, according to some researchers, screenings for breast and cervical cancer fell by 94%. That alone is devastating. Now layer in the effects of cancer disparities. Sociodemographic factors such as race, age, income, sexual orientation or location create barriers to cancer prevention, early detection and treatment.

Black men have the highest overall cancer mortality rate of any U.S. racial or ethnic group, 19% higher than white men, according to the American Cancer Society. Breast cancer mortality in Black women remains 41% higher than for white women. And American Indian, Alaska Native, Hispanic and Black women all have higher incidence rates of cervical cancer than non- Hispanic white women.

Reducing cancer deaths due to disparities will require action and innovation. We encourage health systems and other provider organizations to model their efforts on the proven approaches of Howard University, a top-ranked historically Black research university, and Promise Fund of Florida, a quickly expanding nonprofit.

To start, both organizations employ patient navigators, who do much more than address funding hurdles. At Howard University Cancer Center, navigators sit in on patients’ appointments, facilitate understanding and secure transportation to ensure patients can make it to appointments. The center is focused on going into communities to provide essential education, engagement and preventive care services, reflecting its mission to improve cancer care outcomes and reduce disparities.

The Promise Fund, founded in 2018, connects thousands of uninsured and underinsured women with cancer screenings that lead to earlier diagnosis and lifesaving treatment. Culturally competent navigators identify women who often haven’t set foot in a doctor’s office in years and convince them to re-engage. They find childcare and bring patients to screenings and treatments, translating through barriers of language and our complex medical system.

Under the Promise Fund model, which is essentially a public-private partnership, patients’ first stop is usually a federally qualified health center. For example, Promise

Fund secured the donation of a mammography machine from medical technology company Hologic and placed it at FoundCare, a large FQHC based in Palm Springs, Florida. Before the machine’s arrival, only 10% of FoundCare patients who were referred for mammograms went on to receive one. Now, almost 60% do. The Promise Fund model is being replicated in Florida and gaining national attention.
So how can industry leaders help?

Hospitals, health systems, physicians and anyone concerned about health equity must step up to offer much- needed support. Last year, Promise Fund had one client who, with her navigator, made 25 seven-hour round- trips for radiation treatment to the only hospital in the region that would accept her. Fortunately, that scenario inspired a first-of-its-kind partnership with a local hospital pledging to sponsor the treatment and care for such women.

We encourage other national stakeholders—from federal agencies to large nonprofits—to fully integrate patient navigators into the healthcare system. This should be a covered service by public and private insurance payers. We also need to increase access to care by expanding Medicaid coverage. If the 11 states that have not expanded their Medicaid program would do so, the Urban Institute estimates more than 3.5 million people—mostly people of color— would gain health insurance coverage.

Until we act, remember the price we pay. Without reliable and convenient access to healthcare screenings, how many lives will be lost to cancer?

And, knowing that cancer is more expensive to treat at advanced stages, at what financial cost?

Dr. Wayne Frederick is president of Howard University and the Charles R. Drew Professor of Surgery at Howard University School of Medicine. Nancy Brinker is founder of Susan G. Komen and a founder of Promise Fund of Florida.