How Lessons From the Past Are Shaping a Better Future for Blacks and Cancer

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Since 1976, the month of February has been designated as Black History Month in the United States. The month provides an opportunity to celebrate the many contributions African Americans have made to the country’s history while recognizing inequities and struggles that have divided the nation over the course of time.

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Inequality has spanned across every inch and industry in America, from voting rights to equal pay, and the field of medicine is no exception. At Karmanos Cancer Institute, we acknowledge the disparities and inequities that Black cancer patients face. Since our founding, we have been committed to understanding these issues and leading changes that can shape a better future for underserved populations and all individuals fighting cancer.

The cancer burden facing the African American population is undoubtedly significant. 

  • According to the American Cancer Society, African Americans have the highest death rate and shortest survival of any racial and ethnic group in the United States for most cancers. 
  • A report conducted by the U.S. Department of Health and Human Services Office of Minority Health showed that from 2012-2016, Black women were 40 percent more likely to die from breast cancer than non-Hispanic white women, despite similar rates of diagnosis. 
  • In men, African Americans have lower five-year survival rates for most cancers compared to non-Hispanic white men. 
  • Additionally, fewer Black patients participate in clinical trials than other groups. A ProPublica analysis of data from the FDA found that in 2015, fewer than five percent of patients participating in 24 of 31 clinical trials for cancer drugs were African American.

SEER
Gathering and understanding data is critical in addressing the inequities faced by ethnic minorities. To capture critical data, Karmanos began working with the Surveillance, Epidemiology and End Results Program (SEER) in 1973, as one of the original nine registries. Karmanos contributes approximately 38 percent of the national cancer incidence and survival data for African Americans. The SEER registry is not only used for descriptive studies; it provides a population-based source of cases for case-control and case-case comparisons.

Community Engagement
Karmanos also engages with diverse communities through the Office of Cancer Health Equity and Community Engagement (OCHECE), whose mission is to eliminate cancer health disparities in Michigan by promoting community-engaged research and evidence-based strategies throughout Karmanos’ 46-county catchment area. OCHECE programs include Michigan Cancer HealthLink, an academic-community partnership created to build community capacity to collaborate in cancer-related research. Michigan Cancer HealthLink has eight Cancer Action Councils in six cities in southeast Michigan. Five of these CAC represent neighborhoods or regions, three of which are predominantly African American, while other councils represent populations, specifically LGBTQ adults, Arab Americans and African American men. Through these Councils, Karmanos researchers can hear the voices of those in various populations so they may design research and solutions to suit the needs of cancer patients.

OCHECE also oversees a Research and Advocacy Consortium (RAC). This growing network includes more than 30 faith-based, social service and public health organizations. The RAC works with OCHECE to support evidence-based interventions to improve cancer outcomes; inform diverse communities about clinical trials, cancer control, prevention, screening, and treatment; aid in disseminating and implementing research discoveries; and advancing health policy recommendations. 

Karmanos Research
In addition to the work of the OCHECE, many individual researchers at Karmanos study disparities in health care and propose novel solutions. 

Susan Eggly, Ph.D., professor and a member of the Population Studies and Disparities Research Program at the Barbara Ann Karmanos Cancer Institute and Wayne State University (WSU) School of Medicine, focuses her research on the ways that patients and providers communicate, particularly around clinical trials. She leads the Partnering Around Cancer Clinical Trials (PACCT) study, which encourages physicians to offer trials to all eligible patients using high-quality, patient-centered communication. The study’s overall goal is to test two communication interventions, one for patients and another for physicians, to increase the rates at which Black and white men with prostate cancer participate in clinical trials based on informed decisions.

With permission from patients, family members and providers, clinical interactions are recorded and reviewed to better understand and improve patient-physician communication. In addition, videos from these interactions are re-enacted and used to provide evidence-based instruction to both providers and patients. These videos are utilized in training modules, which include techniques and instruction for better care. As a result, Dr. Eggly received the Anthony and Joyce Danielski Kales Endowed Faculty Award for Innovative Cancer Researcher for her work. Thus far, 16 Karmanos network locations in Michigan have benefited from using these videos and reported positive results. These latest training modules will soon be available nationwide. 

Lauren Hamel, Ph.D., assistant professor and member of the Population Studies and Disparities Research Program at the Karmanos Cancer Institute and Wayne State University School of Medicine, also works towards greater understanding of disparities in cancer care. Along with her team, she identified discernable patterns of behaviors between African American patients with cancer and their oncologists by measuring discrete behaviors like smiling, eye gaze and leaning in that could potentially be modified to help physicians connect with their patients, especially minority patients.

Isaac Powell, M.D., member of the Genitourinary Oncology Multidisciplinary Team, is another Karmanos team member who has dedicated his research to understanding disparities. He focuses on the many ways prostate cancer impacts African Americans in comparison to other ethnic groups. He was principal investigator of the African American Hereditary Prostate Cancer (AAHPC) study to recruit families to identify genes associated with hereditary prostate cancer. This group continued their study with the International Consortium Prostate Cancer Genetics (ICPCG) group to compare hereditary prostate cancer genetic results among African American men from AAHPC families to other ethnicities and other centers around the world. He has also collaborated with Harvard University and Cornell Universityresearchers to report the whole exome sequencing of prostate cancer and potential racial differences, which showed that prostate cancer among African American men grew faster than among other ethnicities. His work identified genes associated with advanced prostate cancer that are more expressed among African American men than European American men.

Health Equity Book Club
In addition to quantitative data, it is important to acknowledge the nuanced experiences, cultural complexities and individual narratives that African Americans report about their health care. One way that Karmanos is opening a dialogue about these stories is through the Health Equity Book Club. Held quarterly, this program aims to educate health care providers on the history of systemic racism in medicine and to set the stage for developing strategies and interventions to eliminate the impact of racial inequities in medical practice and society. This is done through the reading and discussion of texts that explore a range of topics related to equity in health care. 

The group’s first read was “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present,” a 2007 book by Harriet A. Washington that presents a history of the medical industry’s shocking mistreatment of African Americans throughout history, from the era of slavery to now. Led by a diverse group of leaders from Karmanos and Wayne State University (WSU), 115 readers attended this virtual discussion. Over the course of conversation, emotional and disturbing passages sparked deep conversation. The meeting concluded with discussion about steps that can be taken to build trust between medical providers and the African American community.