Amazing advancements against cancer, but not everyone benefits
Cancer-related deaths in the U.S. fell by 26 percent in the 14 years since 2001, according to an annual report released today by the American Association for Cancer Research.
Because there are fewer deaths, the number of Americans living with cancer -- survivors -- has reached an all-time high. As of 2015, more than 15.5 million people in the U.S. suffered from different varieties of the disease, and that number is likely to rise as the population ages. More people have cancer than ever before, but because of advancements in treatment, those people are living longer. However, inequalities in access to cancer treatment and prevention mean that not everyone in the U.S. is benefiting from those advancements equally.
Years of scientific research at both the molecular and population level have identified risk factors that can lead to cancer, and many types are preventable if people are able to change their habits. Obesity, tobacco use, alcohol consumption, and lack of exercise are risk factors that have all been subjects of national health policy initiatives. After sustained anti-smoking ad campaigns, for example, cigarette smoking rates plummeted roughly 30 percent between 1965 and 2015.
However, even with successful risk identification and prevention campaigns, it is still estimated that more than 40 percent of cancer cases diagnosed in the U.S. are the result of potentially modifiable causes.
In 2006, the HPV vaccine was approved to prevent the human papillomavirus, which increases the risk of cervical cancer. Giving children, teenagers, and young adults the vaccine can prevent almost all cases of cervical cancer later in life and even some cases of oral and anal cancer. Unfortunately, fewer than half of children and teens in this country are up-to-date on these shots. This is likely the result of pediatricians not discussing the benefits fully with parents and patients.
Still, we are making progress. Studies on the best ways to screen for cancer – without overscreening -- have led to earlier detection, improving outcomes for many.
Treatment options for different cancer diagnoses continue to grow as well. The U.S. Food and Drug Administration approved 22 therapies in the past year, many of which are completely new ways of approaching the disease. And as scientists learn more about the human genome, they are finding savvy, precise approaches to target the many small mutations in our genes that can cause cancer.
In spite of our advances, the AACR's report showcases a harrowing truth about cancer care: not everyone benefits equally. The fight to create better health results for all segments of the population -- regardless of gender identity, race, country of origin, sexual orientation, or socioeconomic status – continues to be difficult.
"Much of previous research...does not include data from diverse populations…the field of Cancer Health Disparities is moving beyond the obvious epidemiological differences...to being inclusive of subjects for clinical trials and utilizing specimens from diverse subjects," wrote Dr. John Carethers, Professor of Human Genetics at the University of Michigan and a member of the AACR Cancer Progress Report's steering committee, in a statement to ABC News.
Some groups are less likely to get screenings, participate in cancer trials, or get the treatment they need. For example, African-American, Latina, and minority women are more likely to be diagnosed with breast cancer at an advanced stage than white women, with one study citing that women of color are 14 percent more likely to be diagnosed with stage 3 cancer or higher.
Genetic variables might contribute to the ways that the disease is experienced by different groups of people. For example, Black and Latina women are more likely to have a breast cancer that is "triple negative," meaning that their cancer cells do not respond to the three most common hormones that usually promote abnormal growth. Unfortunately this also means that these types of cancers don't respond to available anti-hormonal therapies, and are notoriously more aggressive. However, lack of access to health care, health literacy, and exposure to environmental risks are also significant problems for many vulnerable populations.
Work is being done to address these differences. The AACR advocates for research efforts to address inequalities, and grass-roots work within at-risk communities is also making a difference.
Karen Jackson, an African-American woman and breast cancer survivor, founded the Sisters Network, a national organization that works to reduce the cultural stigma related to breast cancer in the African-American community and increase participation in screenings and trials. "The breast cancer death rate remains unacceptably high among African-American women," Jackson said in an interview published by the AACR. "I stepped out on faith without any funding, just a borrowed desk and my home telephone, and formed the national sisterhood that I craved… African-American women with resources and knowledge to navigate...breast cancer."
The Sisters Network now offers a shared space for women to support each other.
It’s people like Jackson who might play a critical role in narrowing the gap so everyone can share in the victories of the fight against cancer.
Dr. Amisha Ahuja is an internist and writer with the ABC News Medical Unit.
