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Social Inequity is Cancer Inequity

How can healthcare providers help improve outcomes for all?

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Cancer prevention, early detection, and treatment have improved significantly over the years. But not everyone has felt the benefits equally.

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Black Americans, rural residents, and people with no insurance or limited income experience more cancer diagnoses and higher death rates compared to other groups. Among Latinos, cancer is the leading cause of death.

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That these marginalized communities suffer disproportionately from cancer is sadly no surprise. Research shows that the majority of factors that determine disease—some 80 percent—stem from social inequities.

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Consider the barriers faced by a woman working a part-time, low-wage job in a rural area who wants a screening mammogram.

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To attend the screening, she has to miss a day of work—and a paycheck. She lives 35 minutes from the nearest medical center, as do nearly a quarter of rural Americans, and she has to drive or find a ride, since public transit isn’t available in her county.

Chart Source: Survey of U.S. adults conducted Sept. 24-Oct. 7 2018, and Homeland Infrastructure Foundation Level Data Pew Research Center

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It would be understandable if she prioritized her financial stability and skipped that preventive screening. But that's how socioeconomic issues—in this case, a lack of job security and healthcare access—lead to health issues.

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Cancer care and research has not always intentionally considered the needs of diverse patients whose experience of discrimination, poverty, and geographic isolation present unique obstacles to care. But a growing number of cancer professionals are recognizing these problems and working to address these issues.

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“We need to address the social fabric of life. Just as we ask all patients, ‘Do you smoke cigarettes?,’ we need to routinely ask questions regarding the social determinants of health.”

Dr. David W. Rosenthal, Attending Physician, Northwell Health Physician Partners LGBTQ Transgender Program

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So what does more equitable and inclusive cancer care look like?

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Getting more Americans covered.The Affordable Care Act boosted coverage for many Americans, but 2.2 million people—the majority of whom are Black or Latino—still live in a coverage gap. Today, the American Cancer Society Cancer Action Network® is lobbying for Medicaid expansion in the 12 states that have yet to adopt it.

Chart Source: CBPP analysis of 2019 American Community Survey Center on Budget and Policy Priorities, CBPP.org

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Increasing access to quality medical care. On average, rural residents travel about an hour for oncology care. For patients and caregivers who must spend nights away from home, American Cancer Society offers free temporary lodging at 30 Hope Lodge locations throughout the U.S. and Puerto Rico, including two that opened in 2021.

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Increasing access to quality medical care.Nationwide, the increased use of mobile screening units, which remove transportation barriers for patients, is improving cancer detection rates.

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Boosting representation. People of color and LGBTQ+ people are underrepresented across the field of oncology, which contributes to a deficit of culturally competent care. For one doctor, the memories of struggling to obtain quality care as a young immigrant informs her practice today.

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“I was born in Honduras and came to the U.S. when I was three. Healthcare here was difficult to access, and information wasn’t shared with us because my mother didn’t speak English. The experience of not knowing what the doctor is trying to tell you—that stays with you.”

Dr. Carmen Guerra, Vice Chair of Diversity and Inclusion, Penn Medicine

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To help create a more diverse and culturally competent scientific workforce, ACS announced a new cancer research and training program for students of color. Institutions like Dr. Rosenthal's, meanwhile, are improving screening and care for cancers that are more common in the LGBTQ+ community.

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These measures to improve cancer equity are not only about justice for long-marginalized communities. They’re about life and death.

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More than one-third of cancer deaths among American adults could be prevented by eliminating socioeconomic disparities. That won’t happen overnight, but a more inclusive healthcare system is already shaping up—and saving lives.

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“For so many years we just didn’t have the knowledge, skills, awareness, and compassion to stand up for mistreatment of others. This newfound awareness of health equity gives me hope. We’re starting to open our eyes.”

Dr. Carmen Guerra, Vice Chair of Diversity and Inclusion, Penn Medicine

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