How Structural Racism Impacts Cancer Disparities: Takeaways from ASCO 2021

Led by Dr. David Ansell and featuring Drs. Scarlett Lin Gomez and Jennifer J. Griggs, the session titled “More Than the Patient: Structural Racism and Cancer Disparities” presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting explored the role of structural racism in cancer outcomes as well as diversity in the oncology workforce.

Here’s a recap of the session.

Life & Death: The Legacy of Structural Racism

Beginning with Dr. Ansell from Rush University, his presentation focused on reducing racial inequities in breast cancer mortality.

To provide an example of how to do just that, Dr. Ansell shared an article that showed there were no gaps in breast cancer mortality in the 1980s, but interestingly enough, gaps in breast cancer mortality developed in the later half of the 1990s when treatment advancements were developed. These gaps only worsened until 2007, when there was a 62 percent disparity gap.

However, when this data was presented to the Chicago community, critics cited genetics as the cause, arguing that there’s a biological difference and that breast cancer in Black women is harder to treat. To help combat these critiques, a task force was created to improve the quality of care in safety-net hospitals and to navigate women into high-quality treatment protocols.

Because of these interventions, a study published in the New England Journal of Medicine found that the mortality rate of women with breast cancer in Chicago dropped by 39 percent, proving that the task force changed the way that Black women with breast cancer were treated in the city.

To conclude, Dr. Ansell argued that this work conducted in Chicago shows that by addressing inequalities in quality, reducing racial disparities in breast cancer is possible.

Intersection of Health, Place, & Social Justice: Does My Neighborhood Define My Cancer?

Next was Dr. Gomez, a Professor of Epidemiology University of California, San Francisco who discussed how health is embedded in the larger conditions in which patients live and work.

It’s been well documented that there’s a higher burden of prostate cancer in Black men when it comes to incidence and mortality. However, social stressors unique to Black men like racial residential segregation and other adverse experiences have also been shown to cause changes to tumor biology and the immune system, which in turns affects prostate cancer aggressiveness and mortality.

To learn more about the multilevel determinants and characteristics of aggressive prostate cancer in Black men, Dr. Gomez shared a study she and her colleagues are currently conducting called the RESPOND study. RESPOND is a population-based study that’s aiming to recruit 10,000 Black men with prostate cancer to complete surveys about a variety of topics, including social stressors, family and personal history, and prostate cancer treatment.

So far, RESPOND has found that Black men are more likely to live in areas with higher redlining. It also found that 46 percent of Black men experienced moderate to high levels of discrimination from an early-life period and that 36 percent experienced moderate to high levels of lifetime major discrimination, such as being stopped by the police or being unfairly fired from a job.

Dr. Gomez concluded by stressing the importance of recognizing that health inequities arise from fundamental causes and that in order to achieve health equity, upstream social and institutional inequalities need to be addressed.

Effects of Structural Racism on the Oncology Workforce: Propagating the Problem

The last presentation of the session was led by Dr. Griggs, a Professor of Medicine in the Department of Hematology/Oncology at the University of Michigan who discussed the lack of diversity in the oncology workforce.

According to 2018 data, Black, Hispanic, Native American, Alaskan native, and Hawaiian physicians are vastly underrepresented, and the ratio of underrepresentation in oncology is only increasing. Dr. Griggs argued this disparity is so important to address because:

• A diverse workforce delivers high-quality care, especially to people in medically underserved communities
• Black physicians are more likely to serve in underserved areas where there is a greater need and burden of cancer
• More diversity in the workforce leads to more creative problem-solving

Dr. Griggs quoted a lack of access, lack of evaluation, and neglect as structural barriers to participating in the oncology workforce.

That’s why Dr. Griggs recommended the following structural solutions to address racism in this field:

• Recognize policies and structures that shape experiences, such as redlining, policing, and voting rights
• Reframe “culture” as being structurally embedded
• Develop structural solutions beyond anti-bias training since that’s been proven to not be effective
• Practice structural humility

To bring all of this together, Dr. Griggs argued that it’s the responsibility of those in power to dismantle barriers and that overcoming structural barriers is the only way to diversify the oncology workforce.