
Share On Social!
This content is from the “Advancing the Science of Cancer in Latinos: 2024 Conference Proceedings.”
Healthcare Inequity in the Latinx Community
The Latinx population both within and outside the US has significant heterogeneity. [Velazquez-Villarreal] After all, 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. [Perez-Stable]
Latinx individuals are the largest and youngest minority in the US and are projected to account for more than half of the overall growth through 2060. Compared to non-Hispanic White individuals, Latinx individuals are more likely to have lower educational attainment, have lower health literacy, live below the federal poverty level, and lack health insurance or be underinsured. [Moreno] Latinx individuals also have an obesity rate of 44.8%, compared with a rate of 42.2% among non-Hispanic White individuals. [Serra]
Between 1999 and 2018, 21% of US born Latinx individuals and 32% of foreign-born Latinx individuals had food insecurity. [Pruitt] Information from the US Census Bureau on real median household income by race and Hispanic origin of householder in 2021 shows Asian households to be the highest earners, at $101,400, while Latinx households only earn $58,000. [Srinivasan]
Based on 2023 data, Latinx individuals have the lowest representation quotient of medical students enrolled at US medical schools compared to their corresponding percentage of the US 2023 population (12.7% vs 19.1%). [Franco] Furthermore, only 9% of oncologists are Latinx, and only 1/3 of those are women. Retirement could even make these disparities more pronounced, since 20% of Latinx physicians are over the age of 64. [Rios] Underrepresentation in medical oncology has real-world consequences, with very little improvement in cancer deaths observed among Latinx patients since 1990, in contrast to relatively large improvements for non-Hispanic Black and non-Hispanic White patients. [Rodriguez]
Latinx communities are also disproportionately affected by the cancer-causing effects of climate change in the US, [Ellison] disparities in genetic cancer risk assessment, [Hurtado de Mendoza] inequities in psychosocial care, [Costas-Muñiz] and the difficulties of a language barrier. Language concordance, defined in part by the US Department of Health and Human Services (HHS) as the hiring and equitably supporting of “qualified bilingual and multilingual staff, and staff proficient in American Sign Language (ASL), to provide direct ‘in-language’ communication,” is often lacking. [Martinez]
Cancer inequity
Cancer is the leading cause of death in the US Latinx population. [Ellison] Every year, approximately 144,154 Latinx individuals are diagnosed with cancer, 18.3% of which are parents of minor children. Of these recently diagnosed parents, 78.9% are female. [Palacios] When compared to non-Hispanic White breast cancer patients, Latinx breast cancer patients tend to be younger, have a higher grade of disease, have a more aggressive disease, and have higher rates of obesity and type 2 diabetes. [Canola] In fact, breast cancer occurs 10 years earlier in Latin American populations when compared with non-Hispanic White populations. [Cabrera] Across the cancer continuum, Latinx patients demonstrate a lower likelihood of having a primary care provider, lower rates of cancer screening, and a greater likelihood of being diagnosed with advanced cancer. Although cancer accounts for one-fifth of deaths among Latinx individuals in the US, Latinx patients remain largely underrepresented in cancer research and cancer clinical trials. [Moreno]
There are significant disparities in cancer screening in Latinx versus non-Hispanic White individuals, many of which are driven by social determinants of health. [Hernandez-Barco] Many of the cancers with the highest incidence and mortality among Latinx individuals are cancers that are known to be positively influenced by engaging in a physically active lifestyle. [Dieli-Conwright] Furthermore, vaccine shortages, accessibility of services, affordability and availability, provider missed opportunities, and difficulties in tracking vaccine administration are all barriers that prevent administration of cancer-preventing vaccines such as the human papillomavirus (HPV) vaccine. [Martinez] Interventions such as smoking cessation programs known to be effective in the general population, are also difficult to tailor to specific Latinx populations. [Cupertino, Tamí-Maury] Text message-based programs may be an effective and adaptable way to engage Latinx smokers. [Chalela]
The COVID-19 pandemic increased the vulnerability of cancer patients, especially in the Latinx community. Cancer deaths among Latinx individuals in the US increased by 11.7% from 2019 to 2023, which contrasts dramatically with the 0.2% decrease in cancer deaths for Black individuals and the 0.9% increase for White individuals. [Sáenz] Cancer screening also decreased during the time of the pandemic, with 1.3 million fewer colonoscopies performed in 2021 than in 2019, for example. [Coronado] Latinx individuals were impacted by COVID outside the US as well; by June 2020, 27% of world deaths from COVID-19 were occurring in Latin America. [Vilar-Compte] The pandemic also caused a critical shortage of research staff, diminishing trial availability and accrual, including for underserved populations, and leading to substantive delays in results reporting. [Doroshow]
Latinx cancer survivors experience a wide range of disparities, including increased use of financial coping behaviors (such as skipping medications) and worse health-related quality of life outcomes compared to non-Hispanic White survivors. [Graves] Healthcare provider communication and availability of care are vital for Latinx patients, who have a lower probability of receiving timely surgical treatment when diagnosed with early-stage breast cancer. [Farias] These patients are also less likely to receive palliative care. [Moreno] Cognitive behavioral therapy (CBT) has been shown to be effective in cancer survivors and in Latinx individuals, however, barriers to care include transportation, health and mobility problems, scheduling, and scarcity of therapists. [Piette]
Although pediatric cancer survival in the US now exceeds 80%, survival disparities exist for Latinx children, who have higher incidence of several cancers, including leukemia and lymphoma, and have lower 5-year overall survival than non-Hispanic White children (74% vs. 81%). [Aristizabal, Grimes] In fact, children living in Latinx enclaves, defined as neighborhoods with a high proportion of Latinx residents, recent immigrants, and linguistically isolated households, have poorer overall survival after diagnosis of acute lymphoblastic leukemia. [Schraw] Latinx children also have more frequent and more severe treatment-related toxicities with several common key drugs utilized in pediatric cancer regimens. [Grimes] Information on Latinx adolescent and young adult (AYA) survivors is lacking, however, due to low clinical trial participation associated with a lack of awareness of clinical trials, fear of toxicities, transportation issues, a lack of access to specialized cancer centers, high rates of uninsured patients, language and communication barriers, and more. [Casillas]
The underrepresentation of Latinx participants in biomedical research is startling. [Adjei] Despite comprising 19% of the US population, Latinx individuals make up only 3.1% of National Institutes of Health (NIH) clinical trial participants nationwide, and 2.7% of US Food and Drug Administration (FDA) novel drug trial participants. [Mendoza] Latinx data is also often disaggregated due to inconsistent definitions and questionnaires. [Marino] In order to fully understand the complexity of the Latinx cancer landscape, an integrated approach is needed, combining clinical and epidemiological data with proteomics, exome sequencing, genome sequencing, structural genomics, functional genomics, epigenomics, and spatial transcriptomics. [Camargo, Velazquez] Although polygenic risk scores can help predict cancer risk, those currently in use are based on European data, and more work is needed to develop polygenic risk scores designed for Latinx individuals. [Fejerman]
These ideas are just some of the topics that were discussed at the 2024 ASCL conference.
By The Numbers
142
Percent
Expected rise in Latino cancer cases in coming years