Racial, socioeconomic inequities extend to cancer care, too

Jeffrey Freeman admits to being somewhat taken aback when research showed that some disparities typically seen in many facets of everyday life extended to cancer care.  

“I was surprised to see that issues of racial and socioeconomic status were prevalent in chronic illness,” says Freeman, senior health planning research analyst at Common Ground Health.  

He was not, however, as surprised at some of the reasons these disparities were happening.  

He says that factors such as going to work, caring for a child or elderly family member and having reliable transportation are generally top priorities over other matters, including one’s health.  

“When other factors come into play, one’s health often takes a back seat, even when it comes to chronic issues,” Freeman says.  

While cancer affects all population groups, there are social, environmental and economic disparities when it come to cancer care.  

Population groups that may experience cancer disparities include groups defined by race or ethnicity, disability, gender identity, geographic location, income, education, age, sexual orientation and national origin. 

Freeman says inequities exist in cancers across the board.  

Data from the organization shows the most disparities in lung cancer for men and women and breast cancer in women, and Freeman notes other cancers with disproportionate effects are colorectal, cervical and prostate.  

There are many reasons for the disparities, he says.  

Data has shown, for example, that people with lower socioeconomic status may not take the time to focus on their health or they may lack awareness when it comes to issues such as preventative care.  

That is problematic because the earlier people are diagnosed and begin treatment, the better their chances of survival.  

Because of this, there has been an increased focus on the importance of screenings.  

Common Ground Health has partnered with several organizations, including Causeway Community Partners and Cancer Services Program of the Finger Lakes Region, on public health campaigns to raise awareness about the importance of screenings, Freeman says.  

In addition, Common Ground Health works in partnership with the Wilmot Cancer Center’s community engagement program on community education efforts, including the creation of focus groups throughout the region to learn first-hand about some of the barriers people face when it comes to getting cancer screenings.  

The organization also works with area churches and barber shops, where educational materials are distributed.  

Common Ground Health plans to roll out a campaign to increase awareness of the importance of lung cancer screenings soon, Freeman says.  

While work remains, there has been some progress, he says.  

Recent data on breast cancer, for example, shows the disparity in mammograms between white women and other ethnicities is decreasing.  

“We are moving in the right direction,” Freeman says.  

Charles Kamen is a clinical psychologist, assistant professor in the Department of Surgery at the University of Rochester Medical Center and assistant director for community outreach and engagement at the Wilmot Cancer Institute. 

Kamen reviews data from a 27-county region, which includes Monroe County, the Finger Lakes, Southern Tier, Central New York and the Mohawk Valley, which are all areas the Wilmot Center serves.  

He says the region is disproportionately impacted when it comes to cancer rates across the board not only compared to the rest of New York, but the country, as well.  

That includes higher incidences of tobacco-related cancers, such as lung and oropharyngeal, in black communities, where the smoking rate is 27.5 percent compared to around 12 percent among adult smokers in the United States.  

The local region also has a high number of Latinx populations being diagnosed with lymphoma, Kamen says. In response, the center launched a pilot study to determine if the higher incidence rate could be due to pesticide use at farms where there is a large population of Latinx workers.  

“We are using the data we are seeing to understand the disparities in our community,” Kamen says.  

The center also takes a collaborative approach, he says. 

An example is the Wilmot Community Cancer Action Council — comprised of 54 members from 46 community organizations — which looks at regional data and develops opportunities to address cancer disparities.  

In addition to racial and socioeconomic factors, Kamen’s research has focused on factors that lead to health disparities among sexual and gender minority populations, specifically disparities in cancer-related health outcomes and psychological distress. 

He says there is limited data available about a person’s sexual orientation and gender identification in cancer care, noting it is often not collected during clinical intakes.  

Kamen, who works on the issue at the national and local level, says the population has an increased risk of cancer and such data could help improve patient outcomes.  

“They are an invisible community in cancer care,” he says.  

Tonya Brooks, program manager, mobile mammography center at Rochester Regional Health, says the mobile center helps address some inequities in cancer care.  

The traveling unit eliminates one of the barriers that keep women from getting the crucial screening, she says.  

It helps women who are not near an imaging center, or, for some who live close but lack transportation or time, to get the preventative screenings.  

“It’s about convenience and meeting women where they are,” Brooks says.  

The mobile unit — introduced in August 2018 — travels up to six days each week to eight different counties, often near health centers in the outlying counties.  

Since its start, the mobile unit has screened nearly 5,700 women, detected 21 cancers and has provided baseline results to 1,070 women, meaning it was either their first mammogram or it had been 10 years since their last one.  

“Services like this are really having an impact,” she says.  

Diane Kush, operations manager in imaging at RRH, says that in addition to the mobile unit, the health system offers other additional ways to help women who may have challenges when it comes to getting to their appointments.  

Several imaging centers throughout the health system, for example, offer a variety of appointment times to accommodate a woman’s work schedule — often from 7:30 a.m. to 5:30 p.m. during the week, as well as Saturday morning appointments.  

The focus is on providing easy access, Kush notes.  

“It’s about convenience and working around women’s schedules,” she says.  

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