Understanding Barriers in Health Care Among Minority Populations

This week is National Minority Cancer Awareness Week, which draws particular focus to the inequalities and disparities that affect minority populations, when seeking or receiving care for cancer.

This year, nearly 1.6 million people will be diagnosed with cancer. Those numbers will disproportionately affect minority populations. Although complex social, economic and cultural factors play a role, these disparities demonstrate the need for greater outreach, support and commitment throughout the year.

The Abramson Cancer Center Office of Diversity was established in 2013 by the Abramson Cancer Center director, Dr. Chi Van Dang. And, at Penn, researchers at Penn Medicine are trying to collectively study and understand the barriers to screening, healthcare access, diagnosis, treatment, and care. A few such researchers addressing cancer health disparities are highlighted below.

Carmen Guerra, MD, MSCE

Dr. Guerra is the Director of the Abramson Cancer Center’s Office of Diversity. The Office of Diversity supports education, outreach and programs focused on reducing racial and ethnic disparities in the prevention, screening and treatment of cancer. Dr. Guerra’s research focuses on programs that overcome the barriers to accessing cancer screening in minority communities, particularly those that are underrepresented. Along with Dr. Michael Kochman and patient navigator, Alicia Lamanna, Dr. Guerra established the Penn Medicine Colorectal Cancer Screening Navigation Program for West Philadelphia Residents and the newly created Healthy Woman Program. Both programs focus on vulnerable communities and reduce barriers to accessing life-saving cancer screening tests.

Chyke Doubeni, MD, FRCS, MPH

Dr. Doubeni is an Associate Professor and Vice Chair for Research in the Department of Family Medicine and Community Health. He is also a Senior Scholar in the Penn Center for Clinical Epidemiology and Biostatistics, and a Senior Fellow in both the Leonard Davis Institute of Health Economics and the Center for Public Health Initiatives. Dr. Doubeni's research is on colorectal cancer, focusing on racial and socioeconomic disparities in mortality and on the effectiveness of screening.

He currently leads NIH-funded multi-site studies of the comparative effectiveness of colorectal cancer screening. He is also  a co-principal investigator in one of three colorectal cancer research centers of the PROSPR (Population-Based Research Optimizing Screening through Personalized Regimens) network, examining critical questions about factors that limit the optimal performance or effectiveness of colorectal cancer screening in order to remediate avoidable failures in the process of screening.

Learn more about Dr. Doubeni here.

Timothy Rebbeck, PhD

Dr. Rebbeck is a Professor of Epidemiology in the Department of Biostatistics and Epidemiology, as well as Associate Director for Population Science at the Abramson Cancer Center. He leads molecular epidemiologic studies to identify and characterize cancer genes and their relationship with cancer occurrence and cancer outcomes in the context of the demographic, biochemical, environmental, and physiological risk factors.

He has focused this research to address the following questions:
  1) Why do men of African descent have higher incidence and
       poorer prognosis for prostate cancer compared to other
       groups?
  2) How do we refine our understanding of cancer risk and
       prevention in women who have inherited BRCA1 or BRCA2 mutations? 3) How do genes,
       environments, and other contextual factors interact in the etiology of commonly
       occurring cancers?

Curtiland Deville, MD

Dr. Deville is an Assistant Professor and Chief of the Genitourinary and Sarcoma Services in the Department of Radiation Oncology. He serves on the American College of Radiology Commission for Women and General Diversity and is the incoming Vice Chair for the American Society of Radiation Oncology Health Access & Training Subcommittee, both charged with improving physician workforce diversity. He has a research interest in assessing and improving diversity in the cancer physician workforce as a means to addressing health disparities. His research has demonstrated that, in the United States, there is currently a relative lack of minority physicians involved in cancer care compared to other medical fields, and seeks methods to increase Black, Hispanic, and Native American physician training in cancer specialties. Minority providers are more likely to care for underserved and minority populations and physicians that train with racially and ethnically diverse colleagues feel more comfortable seeing culturally diverse patient populations. The American Society of Clinical Oncology set the objective of diversifying the clinical oncology workforce as a “requisite to improving cancer care for the underserved” in their 2009 Disparities in Cancer Care policy statement to ensure that the medical field is well-equipped to meet the needs of our ever-increasingly diverse population.

Jeffrey Silber, MD, PhD

Dr. Jeffrey Silber is the Nancy Abramson Wolfson Endowed Chair in Health Services Research at The Children’s Hospital of Philadelphia and Professor of Pediatrics, Health Care Management, and Anesthesiology & Critical Care at University of Pennsylvania and directs the Center for Outcomes Research at The Children’s Hospital of Philadelphia.

In a recently published paper in JAMA, Dr. Silber examined whether the lower survival rates observed in African American women with breast cancer, compared to white women, were due to differences in biology, presentation, or treatment. Dr. Silber and his colleagues reported that white and black patients present very differently at the time of diagnosis of breast cancer, in terms of variables like tumor size, stage, and health conditions like diabetes and heart failure.

In a large study of more than 100,000 Medicare patients, he found that the percent of blacks with tumors greater than 4 cm is almost double that of whites matched for demographics (21.6% vs. 11.7%). Similarly, 9.2% of blacks present with Stage IV, compared to 5.1% of the demographics-matched whites. Treatment differences accounted for less than 1% of the nearly 13% difference in 5-year survival, whereas presentation differences accounted for over two-thirds of the disparity in survival.

The Abramson Cancer Office of Diversity

The Abramson Cancer Center Office of Diversity supports the Abramson Cancer Center’s mission, vision and values by promoting diversity and inclusion as an integral part of the Center’s goals to understand, prevent, treat and cure cancer.

The Abramson Cancer Center Office of Diversity supports initiatives like the Minority Cancer Health Awareness Week seeking to raise the awareness of cancer health disparities.