February 11, 2021 at 5:00 am ET
The December introduction of the Multi-Cancer Early Detection Screening Coverage Act in the House and Senate wasn’t national front-page news — but it should have been. COVID-19 is, rightly so, the focus of our collective attention. However, the pandemic’s ripple effects on other aspects of our health – particularly for people of color – are starting to come into view. If we don’t heed the warning signs, we could be looking at a tsunami that none of us are prepared for.
This month, we recognize Black History Month, World Cancer Day and National Cancer Prevention Month. Together, they must serve as catalysts for the type of action we need to save more lives in the years to come.
This past year, people of color were at a significant disadvantage when facing COVID-19 – the result, to a significant degree, of weaknesses in coverage and inequities in access to care – and our experience with cancer is resonant.
According to the National Cancer Institute, a total of 1.8 million new cancer diagnoses were expected in 2020 and we experience more than 600,000 deaths annually from the disease. While cancer is the second leading cause of death overall, it is No. 1 among Hispanics.
Meanwhile, Black Americans have higher death rates than all other groups for many cancers. Black men are almost twice as likely as white men to die from prostate cancer. And while Black women and white women may get breast cancer at about the same rate, it is more likely to be found at an earlier stage among white women, and Black women die from it at a higher rate.
These numbers compel us to do better – to keep pushing the bounds of science and technology. In addition to encouraging scientific advancements, including more precision in clinical research, we must assure that we eliminate coverage and payment policies that increase patient risk in service of what may be short-sighted or misguided attempts to limit payers’ financial risk.
There is no single cause for health care and health status inequities. They are the result of a complex set of genetic predispositions interacting with negative social determinants, such as inadequate insurance coverage, environmental toxins and inequitable access to quality health care. Our health care research, delivery and policy construct fail to acknowledge or redress these systemic building blocks of inequity.
The solution is complex. But if we focus on efforts that fundamentally reduce patient risk, we’ll be heading in the right direction. It is increasingly clear that our best chance at slowing deaths from cancer lies in diagnosing it earlier. This will affect everyone, but for people of color the need is more urgent. Perhaps not surprisingly, Blacks are more likely than whites to be diagnosed at a later stage for most cancer types. While it is commonly known that it is most effective to treat cancer before it has spread, the numbers here are revealing. Nearly 8 out of 10 Americans diagnosed with late-stage disease die within five years. But when there is an early diagnosis, nearly 9 out of 10 will live five years or longer.
The question is how we make the latter a reality for everyone.
One way is by embracing and incentivizing scientific innovation. Researchers are in the throes of studying truly paradigm-shifting cancer screening tests, known as multi-cancer early detection, that take advantage of our understanding of genomics and machine learning. These new technologies screen for many cancers simultaneously using just a vial of blood. The approach stands in contrast to the single cancer screenings with which we are all familiar – mammograms, colonoscopies, pap smears. These are a vital part of our effort to beat cancer today, but they are resource intensive and only provide us a window into five out the more than 100 different cancers. Multi-cancer tests, designed to be conducted in primary care offices, will make a sizable dent in the number of late-stage diagnoses and the number of foreshortened lives.
A bipartisan group of forward-thinking members of Congress recognized this and introduced legislation that would allow access to these tests for Medicare beneficiaries. This is the type of policy that is needed to help address cancer’s troubling disparities and better prepare us for future public health crises. Recently, an editorial in The Lancet Oncology noted that all “stakeholders should redouble their efforts on prevention and early detection to ensure cancer healthcare systems are not stressed beyond breaking point in response to another highly disruptive event in the future.”
Hope has been a rare commodity in this past year of the pandemic, and of unprecedented social and political strife. Members of Congress working together on the issue of access to screening technologies is a hopeful indicator of a more equitably supportive future. That is a change we all can use.
Gary A. Puckrein, Ph.D., is president and CEO of the National Minority Quality Forum.
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