Cancer Equity

Socioeconomic and racial disparities in breast cancer have been reported extensively, with risk factors associated with adverse outcomes including race, ethnicity, education, and access to healthcare. Two dominant and related drivers of disparities in breast cancer outcomes are stage at presentation and whether or not a cancer was detected by screening mammography. Breast cancers presenting due to symptoms or with more advanced stage are associated with far worse outcomes. The ability to understand potential underlying drivers of disparities in outcomes are hindered by the fact that existing databases of breast tumors do not distinguish the method of diagnosis of these tumors. Without the context of detection, it is impossible to distinguish biologically aggressive tumors from those that have been merely neglected. In order to understand the underlying etiologies driving breast cancer disparities, there is a critical need to revisit the genomic progression and etiology of breast cancer within the context of real-world, population-based screening detection. We hope to provide unique insights into the underlying molecular etiologies of aggressive breast cancers that present with more advanced stage and have poor outcomes despite routine screening, as well as identify whether there are etiologies associated with aggressive breast cancers that are more prevalent in patients within lower SES neighborhoods.

Funding source: American Cancer Society

Principal Investigator: Michaela Dinan

This project aims to uncover the underlying causes of lethal triple negative breast cancer (TNBC), an aggressive subtype with limited treatment options and poor outcomes. By partnering with the Connecticut SEER registry, the team will identify women who developed lethal TNBC—those who died within five years of diagnosis—and compare them with patients who had indolent, early-stage TNBC and survived at least five years. Using whole exome sequencing, DNA methylation profiling, and advanced mutational deconvolution methods developed by the team, researchers will analyze tumor samples to determine the etiologic factors contributing to each cancer, such as aging, lifestyle exposures, environmental risks, or genetic influences. If successful, the work will provide the first direct evidence of specific causal pathways underlying lethal TNBC, informing future strategies for prevention and early detection.

Funding source: Connecticut Breast Health Initiative
Principal Investigator: Timothy Robinson

The racial and ethnic distribution of the cancer workforce contrasts starkly with that of the general population. Only 2-3% of oncologists identify as Black or Latinx, compared to 13% and 18% of the U.S. population, respectively. While evidence from the business literature suggests that diversity in teams impacts organizational performance, it is not known whether provider team diversity as well as patient-provider racial and ethnic concordance is associated with quality of cancer-related care and outcomes. Through a novel linkage of data from the American Medical Association and Association of American Medical Colleges with the SEER-Medicare data, we will test the hypothesis that the racial and ethnic representation of the oncology workforce varies across regions and patient-sharing networks and that this variation is associated with clinical care.

Funding source: NIH (NIMHD)

Principal Investigator: Cary Gross and Dowin Boatright (NYU Langone Health)

Although colorectal cancer screening can reduce morbidity and mortality from colorectal cancer, screening rates remain below optimal levels. Prior research has established that relatively simple interventions, like reminders to patients and doctors, can improve participation in screening. The goal of this study is to adapt and optimize these interventions for patients who are overdue for colorectal cancer screening. Specifically, we will use text messaging, patient letters, and physician reminders to engage patients in screening. In addition, we will test varied messaging styles head-to-head to identify optimal approaches. Our work will be informed by patients’ perspectives and performed in collaboration with community partners. At the end of this study, we aim to have a simple, scalable, effective suite of tools to improve colorectal cancer screening adherence among patients who are overdue for screening.

Funding source: Yale Cancer Center
Principal Investigator: Ilana Richman

The project, one of the Cancer Intervention and Surveillance Modeling Network (CISNET) Incubator Programs, aims to develop a natural history model for multiple myeloma progression in the United States. The overarching goals will evaluate the impact of novel interventions for multiple myeloma prevention and control, as well as assess whether, under what conditions, and in which ways the goal of eliminating racial disparities can be achieved through the proposed novel intervention strategies and treatment regimens.

Funding source: National Institutes of Health (National Cancer Institute)

Multiple Principal Investigators: Shi-Yi Wang (with Su-Hsin Chang & Graham Colditz)

This explanatory sequential mixed methods study seeks to mitigate racial disparities in non-small cell lung cancer diagnosis, treatment, and outcomes, by identifying modifiable structural and health system/intermediary factors and strategies that influence equity in lung cancer care. We will combine retrospective, population-based studies of racial disparities in lung cancer care with a positive deviance analysis. Through qualitative interviews with key stakeholders in regions with high versus low racial disparities, we will reveal strategies and structures that influence equity in lung cancer care and outcomes. Our hypothesis is that the magnitude of racial disparities varies substantially across counties, and this variation does not arise by accident – there are specific contextual factors, such as structural racism, segregation, and health system factors, that exacerbate disparities.

Funding source: NIH (NIMHD)

Principal Investigator: Cary Gross