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

Intracranial stereotactic radiosurgery (SRS) has become the mainstay of initial and salvage treatment for patients with brain metastases at major academic centers since SRS offers better local control and fewer side effects when compared to whole brain radiotherapy (WBRT). However, SRS is also more expensive and less accessible. The number and characteristics of patients being treated with SRS varies widely across our nation and may be influenced by a variety of factors Since SRS has become such an important part of cancer treatment for brain metastases especially in lung and breast cancer, understanding the drivers of disparities in SRS access is a high priority nationally and locally. Our specific aims are: (1) to characterize disparities in SRS access for patients with brain metastases from non-small cell lung cancer and breast cancer; and (2) to determine the impact of national SRS guideline recommendations on disparities in SRS access.

Funding source: Yale Cancer Center

Principal Investigator: Henry Park

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)

We will create the first comprehensive linkage of a tumor registry, correctional system data, and state vital statistics supplemented with in-depth interviews, to conduct a sequential explanatory mixed methods study of individuals with cancer. We will describe the burden of cancer among individuals with a history of incarceration at the population level in Connecticut. Among Connecticut residents who are diagnosed with cancer (2005-2014), we will assess the relation between incarceration and cancer mortality; the quality of cancer care; and the degree to which incarceration status moderates the relation between race, socioeconomic status and quality of cancer care and mortality. We will then use these data to inform a qualitative study of individual perceptions regarding accessing cancer care in the correctional system and in the immediate post-release period.

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

Principal Investigator: Emily Wang and Cary Gross

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