Addressing Latino Cancer

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This content is from the “Advancing the Science of Cancer in Latinos: 2024 Conference Proceedings.”

Using Science to Address Latino Health Disparities Research

Eliseo J. Pérez-Stable, M.D., is Director of the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH).

This plenary session occurred at 8:30 am., Wednesday, Feb. 21, 2024, at the 4^th biennial Advancing the Science of Cancer in Latinos conference.

Health disparities

Dr. Pérez-Stable began his presentation by discussing populations with health disparities. While race, ethnicity, and socioeconomic status are the fundamental pillars of health disparities science, the intersection of these factors with rural populations, sexual and gender minorities, and people with disabilities are also important to consider. Historically, populations with health disparities have been compared to White populations; however, an effort is being made to establish aspirational goals for all populations based on national metrics, thereby avoiding the assumption that White outcomes are the ideal.

Latin America has been a melting pot of mixed populations for 500 years, with over 20 heritage groups recognized by the Hispanic Community Health Study/Study of Latinos. These groups are distinct, with unique culture, language, and US influence, but are also connected by more similarities than differences. The Office of Management and Budget has even recently proposed to eliminate the two-question approach to identifying race and ethnicity, instead instituting a singular race and ethnicity identifying question with Hispanic/Latino being one of 7 categories to choose from.

Dr. Pérez-Stable and colleagues recently published an analysis of the economic impact of inequities in the US, showing an annual burden of $451 billion based on racial and ethnic minority inequities, and a burden of $978 billion based on education levels of less than a college degree. This cost is based on excess medical care expenditures, lost labor market productivity, and premature death.

Cancer disparities and community engagement

Cancer health disparities among the Latino population are variable. Latina women, for example, have the lowest rates of breast and lung cancers, but the highest rate of cervical cancer. Latino men have the lowest rate of lung cancer but a relatively high rate of liver cancer. Reducing these inequities is multifactorial: standardized measurements and questions are needed to ensure Latinos are not underrepresented, big data is needed to facilitate discovery science, diversity of the scientific and clinical workforce should be promoted, community engagement is needed to build trust for sustainable relationships, and what is already known to work needs to be implemented. One solution to the need for standardization of information across scientific studies is the use of the PhenX Toolkit to measure social determinants of health, developed in 2022.

Several principles determine the efficacy of quality community engagement. Research must be initiated in full partnership with community members, scientists, and the government. Scientists must listen to the concerns and problems of the community and decide on a research plan together. The research plan must be sustainable over time, have shared governance, provided tangible financial support, and include a partnership based on trust, mutual benefits, complementary skills, and a focus on health.

Furthermore, to achieve community engaged research, several paradigm shifts are needed. First, the model of care must change to population health built on strong primary care. Second, the importance of health, and not just health care, must be recognized. Community resources must also be engaged in promoting health, including access to real food and safe places. Finally, structural, and interpersonal discrimination should be recognized and managed.

One example of an NIH program working to build trustworthy partnerships is the Community Engagement Alliance (CEAL), which was established during the pandemic and targets underserved communities and racial and ethnic groups. More recently CEAL has shifted to address more general health concerns including maternal health and climate health and is transitioning further to address and reduce health disparities such as those seen in cancer care. Although this effort is limited by funding, capacity, and expertise, a continued focus on sustaining trust can provide an avenue for meaningful research.

Race and health care

Beyond community engagement, race plays a major role in health care. For example, race may influence patient-clinician communication, which is directly linked to higher patient satisfaction scores, better adherence, and improved health outcomes. African American and Latino physicians care for >50% of minorities, >70% of patients with limited English proficiency, and a disproportionate number of Medicaid/uninsured patients. However, in 2022, only 14% of medical school graduates and practicing physicians were underrepresented minorities.

A 2023 Kaiser Family Foundation survey found that 40% of African American participants, 30% of Latino/Latina participants, and only 6% of White participants reported discrimination in which race or ethnicity was a contributing factor at least three times in the past year. The same survey found that 18% of African American patients, 11% of Latino/Latina patients, and 3% of White patients felt that a healthcare provider or health staff member treated them unfairly or with disrespect because of race or ethnic background over the past 3 years.

Such racism and discrimination affect the Latino population in unique ways. First, Latino Americans have the highest rate of uninsured people in the country, leading to less healthcare access and worse management of chronic conditions. Immigration status is another factor, leading to fear of participating in clinical trials and mistrust in research. A lack of English language proficiency may limit employment options, and accents when speaking English may lead to challenges in understanding. Finally, stereotypical phenotypes of dark skin, non-European features, lower height, and higher BMI affect individual health experiences.

Besides a greater number of Latino clinicians, other solutions may help mitigate this discrimination: greater access to health insurance, care coordination across systems, patient-centered care focused on effective communication and cultural competence, greater equity through electronic health records, and an equity quality measure to gauge performance and risk. With these solutions, along with the NIH programs and the community engaged research mentioned above, the overall health and cancer disparities faced by Latino patients may be reduced.

The Impact of Climate Change and Natural Disasters Across the Cancer Control Continuum

Dr. Gary L. Ellison is the deputy director of the Division of Cancer Control and Population Sciences (DCCPS) at the National Cancer Institute (NCI).

This plenary session occurred at 9:45 a.m., Wednesday, Feb. 21, 2024, at the 4^th biennial Advancing the Science of Cancer in Latinos conference.

Government initiatives to decrease cancer deaths and address climate change.

Dr. Ellison began by discussing the gains that have been seen in cancer mortality in the US since 1990, when there were 215 cancer deaths per 100,000, compared with 146 deaths per 100,000 in 2019, an improvement of about 30%. In 2022, President Biden reignited the Cancer Moonshot with the goal of reducing cancer mortality by a further 50% in the next 25 years. The National Cancer Plan is a framework with eight aspirational goals linked to the Cancer Moonshot’s target of reducing cancer mortality by 50%. Four of the plan’s goals feature prominently in cancer control, and some of the strategies associated with prevention, early detection, and treatment would be supported by the Division of Cancer Control and Population Sciences (DCCPS) with the aim to accelerate progress toward cancer mortality reduction.

On January 27, 2021, the White House issued an executive order on tackling the climate crisis at home and abroad, which established the Office of Climate Change and Health Equity (OCCHE), as well as the NIH Climate Change and Health Initiative. The Climate Change and Health Initiative has developed a strategic framework for approaching climate change that includes partnering with climate and health scholars, as well as emphasizing health effects research, health equity, training and capacity building, and intervention science.

Climate change and cancer

Rising temperatures, extreme weather, rising sea levels, and increased levels of CO₂ have directly impacted human health, leading to increased incidence of heat-related illness, asthma, allergies, communicable diseases, malnutrition, forced migration, and more. The Climate Change and Health Initiative has described needed interventions to combat these changes, including early warning and preparedness, community engagement, targeted prevention and threat reduction, education and awareness raising, and adoption and integration. More research is also needed to understand the full impact of climate change on health.

Climate change also has a direct impact on cancer risk through a number of pathways. Air quality, for example, may be compromised through particulate pollution resulting from wildfires, which causes about 15% of lung cancer deaths and impacts vulnerable cancer survivors. Water pollution may also be affected through fracking, flooding, wildfires, and oil & gas extraction, resulting in contamination with carcinogenic and persistent pollutants. Ozone depletion and ultraviolet radiation exposure have been worsened by climate change, and melanoma incidence is increasing. Finally, food production quality and yields have been negatively impacted by climate change, reducing access to a protective diet for cancer risk and survivorship.

Climate disasters can also disrupt cancer care and lead to workforce and supply shortages. In fact, cancer patients exposed to Hurricane Katrina have been found to have worse long-term cancer survival. Furthermore, lung cancer patients who experience a hurricane disaster during radiation treatment have longer radiation treatment durations and significantly worse overall survival.

Climate and cancer among Latino individuals

Latino individuals are the largest and youngest minoritized community in the US, primarily concentrated in the Southwest and Florida. This diverse community generally has a lower socioeconomic status, often stemming from structural racism, and faces barriers to healthcare. Cancer is the leading cause of death in the US Latino population.

Latino communities are also disproportionately affected by climate change in the US; close to 50% live in California, Texas, and Florida and experience an increase in wildfires, drought, extreme heat, hurricanes, sea level rise/flooding, and increased exposure to burning of fossil fuels. Latino individuals are also overrepresented in outdoor industries including agriculture, construction, first responders, and landscapers, and are therefore more likely to lose time working due to increase in high-temperature days. In fact, 81% of Latinos say addressing climate change is top or one of several important concerns, and 71% say it is affecting their local communities.

The priority of the DCCPS is to expand and enhance research to understand and mitigate the impacts of the environment and climate change on cancer across the cancer control continuum. This includes developing novel measures to more accurately measure exposure and risk, supporting research on the effects of climate change on cancer risk, identifying research infrastructure needs, developing and implementing routine surveillance, supporting research that has an impact on health equity, and achieving better collaboration and coordination with internal and external partners.

1 National Cancer Institute. National Cancer Plan. Accessed August 3, 2024. https://nationalcancerplan.cancer.gov/

2  US Environmental Protection Agency. Climate and social vulnerability in the United States; Pew Research Center. September 2021. Accessed May 4, 2024. https://www.epa.gov/system/files/documents/2021-09/climate-vulnerability_september-2021_508.pdf