Late-Stage Diagnosis of Unscreened Cancer: A Health Disparity
This publication was approved and written in close collaboration with Dr. Gary Puckrein.
Dr. Gary Puckrein is Executive Director of the National Minority Quality Forum (NMQF), in Washington, D.C. He is a featured expert in our health equity-focused Pro Hub that lists inclusive global healthcare professionals committed to advancing inclusive research and providing the highest quality care to all patients.
These articles are written by Diverse Health Hub to summarize complex medical research in order to facilitate deeper understanding. Diverse Health Hub publications are not intended to persuade its readers. We present information to create in-depth conversations that encourage patients to critically think and decide for themselves.
Although there have been significant improvements in cancer outcomes due to advancements in technology, cancer continues to be the second leading cause of death in the U.S. This places a large burden on the American healthcare system. And unfortunately, during the COVID-19 pandemic there has been a significant drop in cancer screenings. This is concerning because the reduction in cancer screenings could potentially reduce the chances of detecting many cancers at earlier stages and thereby possibly lead to a greater amount of suffering from undiagnosed or late-stage diagnoses.
Disparities in cancer outcomes are complex and are driven by a variety of factors, including environmental, behavioral, social, clinical, and cultural factors. Nonetheless, differences in access to high-quality healthcare plays a significant role, particularly among ethnic minorities (Black, Indigenous, and People of Color [BIPOC]). Whatever the cause, barriers to access can reduce the chance of an individual to seek care and take advantage of the various cancer related services available. Therefore, these folks tend to be diagnosed at later and more advanced stages of cancer leading to poorer outcomes. “When considering all cancers combined, Black Americans have higher cancer mortality rates than any other racial group, and cancer remains the leading cause of death for Asians and Hispanics.”
Variations in Stage of Diagnosis
Cancers are often diagnosed after symptoms have developed. Unfortunately, this is often when the cancer has progressed to higher stages, particularly with unscreened cancers. At higher stages, the cancer has spread from a local place to more regional and distant parts of the body. For example, an unscreened cancer such as that of the pancreas is significantly more likely to get diagnosed at an advanced stage than colorectal cancer, which is screened for.
Unfortunately, disparities exist in the stages of cancer diagnosis among racial and ethnic minorities. For example, Black, Hispanic, and American Indian/Alaska Native individuals are more often diagnosed in the later stages of unscreened cancers such as esophageal, ovarian, pancreatic, and stomach cancers than non-Hispanic whites.
Stage of Diagnosis Impacts Cancer Outcomes, Highlighting the Importance of Earlier Detection
The risk of poorer outcomes, including higher rates of mortality are more likely when any cancer is diagnosed at later stages. For example, SEER (Surveillance, Epidemiology, and End Results) data from 2008-2017 revealed that individuals who were diagnosed with distant metastases had an average 5-year mortality rate of 79 percent across cancer types compared to only 11 percent when cancer is diagnosed when the tumor is localized.
Therefore, early detection could play a significant role in improving cancer outcomes and subsequently reducing mortality rates. An early cancer diagnosis may increase access to more treatment options and chances of successful intervention. “An examination of cancer data suggests that 5-year relative survival rates for certain cancers could increase by as much as 90% when screening tools are used before symptoms arise. “
In general, increased life expectancy is strongly correlated with cancer programs focused on early-stage diagnosis. “For example, 63% of patients diagnosed with stage I or stage II, localized non-small cell lung cancer have higher 5-year survival rates compared to only 7% of patients diagnosed with a later-stage diagnosis, stage IV lung cancer.”
The benefits of comprehensive cancer screening recommendations on life expectancy are observed in various types of cancers. “According to SEER data from 2010 to 2016, 5-year relative survival of cancers ranged between 30 – 80% when diagnosed early compared to later-stage diagnoses (Table A).” For those cancers without existing screening options, the chance of late-stage diagnosis is much higher with a likely poor prognosis. Therefore, it could prove beneficial and effective if there were a concerted effort on the part of all healthcare stakeholders to improve screening guidelines for early detection particularly among unscreened cancers.
The poor outcomes associated with later-stage diagnoses is more prominent in racial and ethnic minorities. Across many forms of cancer and their relative stages of disease, racial and ethnic minorities often experience worsened mortality and survival outcomes compared to their Non-Hispanic white counterparts.
Spotlight on Screening
Advances in cancer screenings have significantly improved our capacity to manage and treat the disease. Early detection affords the opportunity for successful treatment of a localized disease before it spreads throughout the body. For example, existing early screening tools such as mammograms, colonoscopies, and pap smears have led to a substantial reduction in cancer mortality. However, recommended screenings available today are limited and detect only 5 cancers – breast, cervical, colorectal, lung, and prostate cancer. The majority of cancers have no early screening tools. Unfortunately, current screening recommendations are underutilized for a variety of complex reasons including the interplay of social determinants of health, geographical or distance barriers, and a lack of health insurance or paid medical leave. This underutilization is even worse for ethnic and racial minorities compared to their Non-Hispanic white counterparts, which may be contributing to disparities in cancer care and outcomes.
An important factor to note is that some screening guidelines do not consider racial and ethnic disparities in risk factors. Therefore, it would behoove various stakeholders to tailor screening criteria to minority communities as necessitated.
Though early detection efforts have contributed significantly to improvements in cancer care and management, there is still more work to be done in minority communities to increase adherence to guidelines and improve outcomes including:
Outreach and policy proposals by stakeholders must focus on improving awareness and addressing inequities impacting the health of racial and ethnic minority groups.
Developing more targeted guidelines and recommendations that address the unique barriers facing minority populations.
Strategies should also look to increase health literacy and utilize culturally-tailored educational and communication efforts that can be leveraged by trusted patient advocates in the community.
Policy Recommendations
“Cancer risk-reduction efforts should incorporate policy solutions and data-driven approaches that prioritize addressing systemic barriers to cancer screening and services across racial and ethnic minority groups. Progress to close gaps in cancer care between racial groups relies on key stakeholders, including patients, providers, researchers, diagnostic companies, advocacy groups, policymakers, regulators, federally funded organizations, and payers.”
The following policy changes are recommended to reduce disparities in outcomes across racial and ethnic minority groups. Though these recommendations will address the inequalities in cancer care, they will nonetheless help improve outcomes for all cancer patients.
Developing guidelines and recommendations for early cancer detection and screening that keep pace with rapid technological advancements and reflect the unique needs of minority and disadvantaged populations.
Creating incentives that drive continued innovation in early detection and screening technologies.
Ensuring coverage of and access to early detection and screening technologies in both private and public insurance plans covering underserved communities.
Developing better measures and standards for assessing impact of early detection and screening in minority communities, including the cancer detection rate, as well as the effectiveness and impact of policy changes.
Supporting broad initiatives that promote community outreach and education.
Broderick Rodell is an educator whose passion and calling is to aid others in the art of practicing a life well-lived. He sees his role as a guide to those interested in acquiring the knowledge, skills and practices that will enable them to develop the characteristics that are conducive to self-realization, well-being, and flourishing.
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Source
Puckrein, G. (April 28, 2021). Earlier Detection of Cancer in Minorities Holds Promise to Close Persistent Disparities in Health Outcomes. National Minority Quality Forum website. Accessed July 7, 2021. https://ai-healthnet.com/multi-cancer-early-detection/
