Introduction: 2022 Advancing the Science of Cancer in Latinos

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This is part of the “Advancing the Science of Cancer in Latinos: 2022 Conference Proceedings,” which summarizes findings and discussions of the 2022 Advancing the Science of Cancer in Latinos Conference on Feb. 23-25, 2022, in San Antonio, Texas.

Healthcare inequity in the Latinx community

The United States healthcare system is rife with systemic inequities affecting the Latinx community, the largest ethnic minority in the country with a population of 60.6 million [Estrada]. Health disparities include higher rates of infant mortality, stroke, cancer, heart disease, diabetes, hypertension, and COVID-19, and are often rooted in systemic racism and unconscious bias. [Webb Hooper, Duma] Latinx patients, especially those who are uncomfortable discussing care in English, are often stereotyped as unintelligent and non-compliant. In a meta-analysis of 15 studies, 13 found that healthcare professionals showed statistically significant moderate levels of bias against people of color. [Duma]

In the COVID-19 pandemic, cases among the Latinx population have been 1.3 times higher than in the White population, with 3.2 times more hospitalizations and 2.3 times higher death rates. [Del Rio] Furthermore, among high-risk patients, such as pediatric cancer patients, those of Latinx ethnicity were disproportionately affected compared with other racial and ethnic groups and experienced more symptomatic illness. [Flatt] Such disparities are often due to social determinants of health (SDoH), which account for at least 60% of the variance in health outcomes, a much greater percentage than the pure effects of biological and genetic factors. [Nunez-Smith] Misinformation is another challenge affecting the Latinx community, with social media misinformation even more prevalent in Spanish posts than in English. [Goddard]

SDoH include spatial patterns of poverty, lack of access to nutritious food, environmental toxins, educational disadvantage, health literacy, and more. [Nunez-Smith] One of the more important SDoH, socioeconomic status, shows a startling association with mortality. US residents in a household of four with an income less than $25,000 show a mortality ratio of 3:1 when compared to those with a household income of greater than $115,000. [Perez-Stable] In Texas, Latinx men and women are the least likely to have health insurance of any major racial or ethnic group. Among those 18 to 64 years of age, 26% of Latinx individuals were uninsured, compared to 9% of White individuals in 2017-2018. [Estrada]

Cancer inequity

Cancer is the leading cause of mortality in the Latinx population, accounting for 20% of deaths. [Estrada] In fact, 1 in 3 Latinx men and women will be diagnosed with cancer in their lifetime, with 1 in 5 men and 1 in 7 women dying from the disease. [Estrada] From 1999 to 2016, cancer cases increased by 106.0% in the Latinx community, compared to a 17.5% and 50.0% increase in White and Black communities, respectively. [Sáenz]

Lung cancer is the leading cancer killer in Latino men, and breast cancer is the leading cancer killer in Latina women. [Taverna, Velazquez] Latinx lung cancer patients die earlier than White patients, with 5.2 years of potential life lost compared with just 4.3 years for White patients. [Cress] Latino ethnicity and living in the lowest-income neighborhoods are associated with a higher risk of gastric cancer diagnosis, and Latino populations have the highest incidence rates of liver cancer compared with other ethnic groups. [Long Parma, Setiawan] B-Cell acute lymphoblastic leukemia (B-ALL), the most common childhood malignancy, disproportionately affects Latinx children, who are 1.2-1.75 times more likely to develop ALL than their White counterparts; and Latinx adolescents are 2.09 times more likely. [Dovat]

The cancer care continuum

These inequities affect Latinx cancer patients across the entirety of the cancer care continuum. Obesity, for example, has been shown to increase cancer risk, cause delays in diagnosis, alter treatment plans, and increase complications associated with comorbidities. [Bandera] The obesity rate for Latinx adults in the United States is 44.8%, second only to Black adults at 49.6%. [Bandera, Rodriguez-Rodriguez] Cardiometabolic comorbidities are also higher in Latinx populations, which are often found in ethnic enclaves, or areas of ethnic density based on language and birthplace. [Maras, Diaz] These ethnic enclaves are associated with higher obesity rates, and can often be food deserts, have high poverty rates, lack green spaces, and be areas of high stress due to violence. [Diaz]

Another part of the cancer continuum affecting Latinx patients is stress management and mental health. [Costas-Muniz] End-of-life care is another concern, with Latino patients less likely to complete do-not-resuscitate orders, have living wills, or have designated health care proxies. [Maciejewski] This results in a higher likelihood of aggressive EoL care, including increased ICU admissions and chemotherapy use. [Tergas]

Disparity in clinical trial representation

Despite representing 18% of the population, Latinx participants only represent 4-8% of clinical trial participants. [Lynce, Fashoyin-Aje, Trevino]

In a recent study of almost 6000 precision oncology trials, all minority groups were underrepresented, with Latinos showing the greatest disparity. [Lynce] ] In trials for oncology drugs approved by the FDA from 2008 to 2018, only 630 of the 70,201 patients who reported their racial background were Latinx. [Rodriguez] When comparing participants in clinical trials from 1996-2002 with participants from 2003-2016, Latinx participation has decreased, with 3.1% Latinx participation prior to 2002 compared with 2.6% Latinx participation after 2003. [Rivera] The Cancer Genome Atlas (TCGA) program, a large publicly available genomic database, also has a very low number of Latinx participants with only 3% of participants identifying as Hispanic or Latino. [Ziv, Dutil]

Practical steps for addressing inequity

Advancing the Science of Cancer in Latinos, a conference held from February 23rd to 25th, 2022, brought together leading Latinx healthcare voices in San Antonio, TX to discuss these inequities and share practical approaches for moving forward. Presenters included physicians, researchers, survivors, policy makers, and industry leaders from across the US and Latin America. It was agreed that dismantling racial disparities in the healthcare system must involve diversity at every level, from educators to physicians to administrators to legislators. A diversity of voices always leads to a broader understanding of patient experience. [Santos, Winn]

Intervention in Latinx populations must also begin with an understanding of language and culture, and these communities should be engaged with sincerity and a willingness to listen to those affected by the issues being studied. [Sanchez-Johnsen] Successful health care interventions are often driven by multi-layered community networks through the identification of root causes and solutions, as well as community resources. [Molina, Tortolero-Luna] Community-based health workers can provide education, screen for social determinants of health, schedule screenings, and follow patients until screenings are complete. [Jones]

Latinx participation in clinical trials must also be increased through more purposeful study design, more flexible inclusion criteria, and fewer economic barriers to participation. [Duma, Dovat, Rodriguez, Trevino, Penedo, Perez, Kuri] Through greater Latinx participation and more diversified genomic testing, Latinx presentations across all diseases can be better understood. [Ziv, Lynce, Dutil, Cress, Dovat] In this way, more individualized treatment plans with fewer side effects can be implemented. [Taverna]

Cooperation between research programs, especially across borders, is another necessary strategy moving forward. Many initiatives can be emulated in this regard, including the Latin American Cancer Research Network (LACRN), the Mexican National Institute of Public Health, the Puerto Rico Breast Cancer Genetics and Genomics Study (PUR-BCGG), and the Leading Pathways study. [Lajous, Llera, Dutil, Penedo]

The presentations outlined below discuss the findings of Latinx leaders in the areas of cancer research, healthcare disparity, COVID policy, clinical trial inequity, international cooperation, community intervention, end-of-life care, and social justice. The information presented, however, merely represents a beginning, with the hope that dialog and collaboration will continue into the future, providing new solutions for the elimination of health disparities among Latinx populations.