April is National Minority Cancer Awareness  Month. As I reflect on the continued need for improvements in health equity and the impact of cancer on racial and ethnic minority groups, I am acutely aware of the disparities in diagnosis and treatment that have persisted for many years. Much work remains to resolve these inequities, starting with a better understanding of the factors that lead to increased rates of and/or higher stage diagnosis of many cancers in people of color. Proactive measures are needed to ensure that non-White cancer patients have the same care experience as White patients.

AdvaMed members are committed to access for all patients to life-saving cancer diagnosis and treatment technology. Our organization has embraced Principles on Health Equity, a  good base from which to examine some of the factors that may influence cancer screening, diagnosis, and treatment for patients of color. These principles focus on four core areas: eliminating bias in patient care, improving awareness regarding available treatments, improving access to care regardless of insurance status and via better deployment of technology to facilitate health access, and diversifying the patient population and investigators in clinical research.

As we consider the connection between these principles and the cancer diagnosis and treatment experience of some patients of color, several questions come to mind:

• Why do inequities in cancer outcomes exist and persist?
• Are all patients being offered the full range of treatment options? If not, why?
• Does insurance type impact the ability to receive appropriate cancer care?
• Are the causes of cancer in minority patients being adequately researched and understood?

The disparities facing patients of color are stark. These inequities require continuous focus and determination from every aspect of the health care system to resolve. Patients of color experience higher incidence and lower survival for many cancers, with African Americans having the highest cancer death rate of any other group in the United States.¹ High rates of colon cancer in African American patients led to recommendations for screening at age 45 for these patients beginning in 2005—16 years before the 2021 U.S. Preventive Services Task Force announcement of a screening age of 45 for all people at average risk for colon cancer.^2,3 Also, the rates of detection of deadlier and higher stage breast cancer is higher in African American patients. ⁴ While incidence rates of breast cancer in White women are slightly higher, the survival rate for the disease is lower in women of color—particularly African American women.⁵ Rates of prostate cancer and mortality are also higher in patients of African American descent.⁶ While some of these statistics could be attributed to lower rates of screening, the differences also suggest that additional research into the causes and impact of cancer in people of color is merited. The way in which these patients seek and receive cancer care should also be evaluated.

A Role for Medical Technology

Medical device manufacturers develop tests and technologies that are instrumental in screening, diagnosing, and treating cancer. From mammography and ultrasound to colonoscopy and radiation therapy, our industry has been at the forefront of cutting-edge treatments that give patients their best chance at surviving many types of cancer. In vitro diagnostic (IVD) tests screen for cancer and identify genetic markers and mutations that help target therapies for certain cancers and impact treatment recommendations. As an industry we should continue to embrace every chance to ensure that our cancer technologies, from development to market, are touching all the patients who could benefit from them.  There is room for improvement not only in the research phase but also in the dissemination of information and increased awareness regarding available treatments

Getting Information About the Technologies We Make to Patients

As we work to address inequities in cancer care and outcomes for patients or color, the medical device industry, in conjunction with other stakeholder partners (e.g., providers, insurers, policy makers), should continue examining how best to get technologies to the patients who need them and who are disparately suffering and dying from cancer. I would offer the following suggestions:

• Make information regarding symptoms and self-screening widely available
• Increase awareness regarding screening methods, eligibility, and guidelines (including age, frequency, extenuating conditions/factors)
• Ensure that providers and patients are aware of the full range of diagnosis and treatment options (IVD and other diagnostics, surgery, chemotherapy, radiation therapy, or a combination of approaches)
• Work with policymakers and insurers to ensure that cancer care is meted out in an equitable fashion and that patients can receive the care that best treats their condition
• Promote understanding, singly and/or through partnerships, about cancer risks and encourage patients to know their risks (age, symptoms, family history, race/ethnicity, and other genetic factors)
• Include more diverse subjects in research to determine genetic and other markers and to generate evidence regarding the disease process

Industry’s role as a resource is pivotal. Together we can all work to change the way cancer impacts minority communities and improve outcomes for everyone.

Learn more about AdvaMed’s Health Equity work.

DeChane Dorsey is executive director of AdvaMed Accel, the division for small and start-up medical device technology companies. She also leads health equity work organization-wide.

Citations

1. NIH National Cancer Institute,  U.S. Mortality 2015–2019, Age-Adjusted Rate per 100,000
2. Agrawal S, Bhupinderjit A, Bhutani MS et al. Colorectal cancer in African Americans. Am J Gastroenterol 2005; 100: 515–523; discussion 514.
3. Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement. JAMA 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238 Corrected on August 24, 2021.
4. African American Women More Likely to Die of Triple-Negative Breast Cancer. JAMA. 2021;326(7):591. doi:10.1001/jama.2021.13107.
5. Watts, Erica, Breast cancer death rate in Black women: Does DNA repair play a role?. Medical News Today February 13, 2022
6. Tsodikov A, Gulati R, de Carvalho TM, et al. Is prostate cancer different in black men? Answers from 3 natural history models. Cancer. 2017;123(12):2312-2319. doi:10.1002/cncr.30687