US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)

U.S. Ethnicity and Cancer:Learning From the WorldU.S. Ethnicity and Cancer:Learning From the World

Barri M. BlauveltCEO, Innovara, Inc.www.innovara.comOctober 16, 2013

http://www.innovara.com/

In 2009, President Barack Obama called for a new, integrated global health strategy and for “…a new effort to conquer a disease that has touched the life of nearly

every American, including me, by seeking a cure for cancer in our time.”1

In 2009, President Barack Obama called for a new, integrated global health strategy and for “…a new effort to conquer a disease that has touched the life of nearly

every American, including me, by seeking a cure for cancer in our time.”1

1) Dunham, Will. “Obama cancer cure vow requires more funds: experts.” Reuters. Feb. 25, 2009. Available at: http://www.reuters.com/article/healthNews/idUSTRE51O7JC20090225

Picture: http://www.ncrr.nih.gov/strategic_plan/online_version/images/people-map.jpg

This presentation:This presentation:

Demographics of cancer and global impact

Cancer in different ethnic groups

Ethnic challenges in research

Influence of Health Insurance and SES

Prevention and Obesity

A Potential Model for National Cancer Control

Cancer - a Growing ProblemCancer - a Growing Problem

2) Boyle and Levin (eds.). World Cancer Report 2008, Lyon: International Agency for Research on Cancer, 2008.3) New cancer cases will grow 30% by 2020; current year estimates suggest global economic impact exceeds US $300bn. Economist Intelligence Unit, 2009. Downloadable at www.eiu.com_info.com

Cancer 2nd leading cause of death in world2; soon to be No. 1

In past 30 years, the burden of cancer has doubled2

30% growth in new cancer cases by 20203

2/3 of new cases from lower- and middle-income countries.2, 3

Estimates suggest global economic impact exceeds US $300 Billion 3

http://www.eiu.com_info.com/

Inequitable Allocation Of Cancer ResourcesInequitable Allocation Of Cancer Resources

Only 5% of resources invested in developing world.3

Less than 15% of clinical research spending in developing world4

3 major sources account for 2/3 of research funding5 : US Government - 34% Top 24 pharmaceutical companies - 22% EU health care and university systems - 10%

“The irony and the tragedy is that around the world the policy community in conjunction with medical providers already can do much to control this devastating disease.”6

“The irony and the tragedy is that around the world the policy community in conjunction with medical providers already can do much to control this devastating disease.”6

4) Clinicaltrials.gov (www.clinicaltrials.gov), Sep. 28, 20095) ECRM survey (www.ecrmforum.org) cited in “Responding to the challenge of cancer in Europe”. Original survey data represent research funding in 2003. Funding estimates were inflated to 2009 US$ using the US Consumer Price Index.6) Kort EJ, et al. The decline in U.S. cancer mortality in people born since 1925. Cancer Research 2009; 69(16): 6500-6505

Breast Cancer Exemplifies Inequitable AllocationBreast Cancer Exemplifies Inequitable Allocation

In USA and EU effectively being controlled in up to 80% of some populations of women

However, breast cancer is leading cause of cancer death in most non-white women around the world (including US)6

Why this disparity between white non-Hispanic women and non-white women in breast cancer deaths? Reasons explored in a joint study of University of Massachusetts and

Johns Hopkins in an international horizon scanning study in breast cancer, from 2006 to 20087

7) Buchanan D, Blauvelt B, et al. Breast cancer and ethnicity – A survey of thought leaders in Latin America, Asia and the Middle East. The Breast Conference, Sept. 2008.

UMass/Johns Hopkins Horizon Scanning StudyUMass/Johns Hopkins Horizon Scanning Study

Encompassed 30 countries across 3 regions of the world: Asia, Latin America and Middle East/Africa

Accounts for approximately 60% of world population

90% of collective population is non-White

Key Finding: As in US, non-Caucasian ethnicities present with breast cancer at a significantly younger age and with more aggressive tumors than their white counterparts

Key Finding: As in US, non-Caucasian ethnicities present with breast cancer at a significantly younger age and with more aggressive tumors than their white counterparts

UMass/Johns Hopkins Horizon Scanning Study7UMass/Johns Hopkins Horizon Scanning Study7

Part of this difference for ethnically diverse groups is attributed to differences in: Lifestyle and cultural attitudes Lack of prevention and early detection Lack of education and advocacy Issues related to access to care Affordability Environmental factors Genetics

Most of the countries involved in the study noted they lacked the resources and know-how to conduct adequate research.8,9

8) El Saghir NS, Khalil MK, et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis. International Journal of Surgery, (2007) 5, 225-233.9) Anderson BO et. al. “Guidelines for International Breast Health and Cancer Control-Implementation" Cancer, October 15, 2008 Supplement

Cancer Guidelines and Policies Need to AdaptCancer Guidelines and Policies Need to Adapt

“The [NCCN] Guidelines, which these countries try to follow, simply do not work for ethnically diverse and economically challenged populations.”

“The [NCCN] Guidelines, which these countries try to follow, simply do not work for ethnically diverse and economically challenged populations.”

NCCN and other cancer guidelines mainly are based upon research done in white populations and may not be appropriate

If treatment guidelines don’t work in ethnically diverse and economically challenged populations outside of the USA, they also are unlikely to work in similarly challenged populations within the USA

A significant need and opportunity exists for greater diversity in cancer, epidemiology, socioeconomics and related research in order to formulate success strategies and policies to control cancer in America’s increasingly culturally and ethnically diverse populations

Cancer in Different Ethnicities in USA:Hispanics

Cancer in Different Ethnicities in USA:Hispanics

Compared to non-Hispanic Caucasian populations:

Both Hispanic men and women are twice as likely to have and die from liver cancer

Hispanic women are 2.7 times more likely to have stomach cancer

Hispanic women are twice as likely to have cervical cancer, and 1.5 times more likely to die from cervical cancer

10) Office of Minority Health, US Department of Health and Human Services, Cancer and Hispanic Americans, http://www.omhrc.gov/templates/content.aspx?lvl=2&lvlID=54&ID=3323

Cancer in Different Ethnicities in US:Asians/Pacific Islanders

Cancer in Different Ethnicities in US:Asians/Pacific Islanders

Compared to non-Hispanic Caucasian populations:

Asian/Pacific Islander men are twice as likely to die from stomach cancer

Asian/Pacific Islander women are 2.6 times as likely to die from the same disease

Both Asian/Pacific Islander men and women have three times the incidence of liver & Intrahepatic Bile Duct cancer

11) Office of Minority Health, US Department of Health and Human Services, Cancer and Asian/Pacific Islanders, http://www.omhrc.gov/templates/content.aspx?lvl=2&lvlID=53&ID=3055

Cancer in Different Ethnicities in US:African Americans

Cancer in Different Ethnicities in US:African Americans

African Americans have the highest mortality rate of any racial and ethnic group for all cancers combined and for most major cancers

Compared to non-Hispanic Caucasian populations:African American men are twice as likely to have

new cases of stomach cancer

African American women are 10% less likely to have been diagnosed with breast cancer, however, they were 34% more likely to die from breast cancer

12) Office of Minority Health, US Department of Health and Human Services, Cancer and African Americans, http://www.omhrc.gov/templates/content.aspx?lvl=2&lvlID=51&ID=2826

Differences in Breast Cancer by Race & EthnicityDifferences in Breast Cancer by Race & Ethnicity

In US, mean age of breast cancer diagnosis: • American Indian - 54 ±13• Hispanic - 56 ±14• Asian/Pacific Islanders - 57±13• Blacks - 57± 17• Whites [Caucasians] - 62 ±14

Blacks, American Indians, and Hispanics:• had 1.7 to 2.5 fold increase risk of stage III and stage IV breast tumors• had 1.3 to 2 fold greater risk of breast cancer related mortality

In stage I or II breast cancer patients with tumors smaller than 5.0 cm, Blacks, other Asians and Pacific Islanders, Mexicans, and Puerto Ricans were 20% to 50% more likely to receive inappropriate primary surgical and radiation breast cancer treatment

13) Christopher Li, et al: Differences in Breast Cancer Stage, Treatment, and Survival by Race and Ethnicity, Arch Intern Med. 2003;163:49-56

Ethnic Challenges in Cancer Research and CareEthnic Challenges in Cancer Research and Care

Some examples of mistrust, fear, social and other cultural beliefs: • Some fear genetic research in case they may be considered unmarriageable8 • If people knew they had “cancer genes” they will consider cancer

“inevitable” and therefore not try to adopt healthier lifestyles14 • Chinese may be reluctant to try to be part of any research for fear of learning

they have and being rejected due to HBV/HCC15

• In Africa, people are reluctant to participate in cancer research because they fear learning that they have HIV and other diseases.16

• In some countries, women chose to have breast cancer or delay seeking treatment, for fear of losing their hair or surgical disfigurement7

14) Lara, A (Deputy Minister of Health, Federal Government of Mexico), “The Delta Project”, July, 2005. 15) Cheng AL, et al. “Epidemiological Perspective: HBV Vaccinations and Implications in HCC Development.” International Liver Cancer Association, Sept. 2009. 16) Kerr D et al, London Declaration on cancer control in Africa (presentation and discussions during the Cancer Control in Africa Meeting, May 10 – 11, 2007, London, UK.

Some Further Examples of DisparitiesSome Further Examples of Disparities Studies on communications with patients

• Oncologists appear to communicate differently with breast cancer patients, depending on the women's race, age, and other factors17

• Poor communication of mammogram results may explain disparities in breast cancer diagnosis and outcomes18

Studies on screening and treatment• Poor, minority, and uninsured individuals have reduced access to screening and surgery

for colorectal cancer19

• Perceived racial discrimination in adherence to screening mammography guideline20

• Minority women are less likely to receive adjuvant therapies following breast cancer surgery21

• Disparities in receipt of chemotherapy following ovarian cancer surgery22

• Socioeconomic barriers exist to timely diagnosis and treatment of prostate cancer in black men23

17) Siminoff, Graham, and Gordon, Patient Educ Counsel 62:355-360, 2006 (AHRQ grant HS08516). See also Carter, Zapka, O'Neill, et al., Palliat Support Care 4:257-271, 2006 (AHRQ grant HS10871).18) Jones, Reams, Calvocoressi, et al., Am J Public Health 97(3):531-538, 2007 (AHRQ grant HS11603) and Dailey, Kasl, Holford, and Jones, Am J Epidemiol 165(11):1287-1295, 2007 (AHRQ grant HS15686).19) Phillips, Liang, Ladabaum, et al., Medical Care 45(2):160-167, 2007 (AHRQ grants HS10771 and 10856); Diggs, Xu, Diaz, et al., Am J Manag Care 13(3):157-174, 2007 (AHRQ grant T32 HS00059); Zhang, Ayanian, and Zaslavsky, J Qual Health Care 19(1):11-20, 2007 (AHRQ grant HS09869). See also Guerra, Dominguez, and Shea, J Health Commun 10:651-663, 2005 (AHRQ grant HS10299).20) Dailey, Kasl, Holford, and Jones, Am J Epidemiol 165:1287-1295, 2007 (AHRQ grant HS15686). See also Jones, Reams, Calvocoressi, et al., Am J Public Health 97(3):531-538, 2007 (AHRQ grant HS11603); Rauscher, Hawley, and Earp, Prev Med 40:822-830, 2005 (AHRQ grant T32 HS00007).21) Bickell, LePar, Want, and Leventhal, J Clin Oncol 25(18):2516-2521, 2007. See also Bickell, Wang, Oluwole, et al., J Clin Oncol 24(9):1357-1362 (AHRQ grant HS10859).22) Du et al, Studies finds disparities in receipt of chemotherapy following ovarian cancer surgery. Int J Gynecol Cancer 18(4):660-669, 2008 23) Talcott et al. Socioeconomic barriers exist to timely diagnosis and treatment of prostate cancer in black men. Cancer 109(8): 1599-1606, 2007

Clinical Trials Lack Ethnically Diverse Representation

Clinical Trials Lack Ethnically Diverse Representation

Clinical Trials• Fewer than 10% of U.S. clinical trial participants come from African-

American, Latino, and Asian populations 24

24) Evelyn B, Toigo T, Banks D, et al. Participation of racial/ethnic groups in clinical trials and race related labeling: a review of new molecular entities approved 19951999. J Natl Med Assoc. 2001;93:18S-24S.

Source: Baseline Study of Patient Accrual Onto Publically Sponsored Trials, “Coalition of Cancer Groups of the Global Access Project, National Patient Advocate Foundation, April 2006.

Barriers to Clinical Trials Result in Underrepresentation of Non-Caucasians

Barriers to Clinical Trials Result in Underrepresentation of Non-Caucasians

Participant Barriers to Participation:

• Mistrust• Lack of awareness• Cultural barriers• Language/Linguistic differences• Socioeconomic obstacles• Cost/Lack of insurance• Study design eligibility criteria

25) The EDICT Project: Policy Recommendations to Eliminate Disparities in Clinical Trials: EDICT: Eliminating Disparities in Clinical Trails (10/2008, Version 2 )

Barriers to Clinical Trials Result in Underrepresentation of non-Caucasians

Barriers to Clinical Trials Result in Underrepresentation of non-Caucasians

Physician/Investigator Barriers to Referring Participants to Clinical Trials:

•Lack of non-Caucasian investigators

•Lack of physician referral

•Lack of physician awareness

•Participants are also often excluded from clinical trials due to characteristics, preferences, and circumstances of the physicians who conduct or refer patients to clinical trials

25) The EDICT Project: Policy Recommendations to Eliminate Disparities in Clinical Trials: EDICT: Eliminating Disparities in Clinical Trails (10/2008, Version 2 )

Opportunities to Increase Diverse Ethnicity Participation in Clinical Trials

Opportunities to Increase Diverse Ethnicity Participation in Clinical Trials

Physician’s ethnicity is an important factor in influencing patient participation in a clinical trial• Black and Latino (and some Asian) physicians are more likely to treat

patients of a similar race and ethnicity 26

Issue of underrepresentation of African Americans in research implies that more minority physicians should be recruited into clinical research [and into cancer specialties]. 26

Over 85% of communications on participation in clinical trials by both US government (NCI, NIH and others) and the major pharmaceutical companies found to be only available in English. 27

• Fewer than 10% were bi-lingual (and almost none multilingual)

26) Getz K, Peddicord D, Minorities underrepresented in clinical trials, Special to The Washington Post, October 2, 2008. 27) Innovara, Inc. How Difficult Is It to Enroll in Clinical Access Trials? Scheduled for publication in January, 2010.

Influence of Health Insurance and Socioeconomic Status (SES)


As of 2009, 1:4 non-Caucasian in the USA will forego the cancer treatment due to costs (1:8 in overall population)

In a breast cancer study, women who were uninsured or had Medicaid coverage compared to those who had Medicare or private insurance were 65% less likely to receive adjuvant treatment28

Researchers compared black and white men diagnosed with prostate cancer from the North Carolina Cancer Registry23 Both had to travel similar distances for health care23 Black men still had less access to care23

Also had poorer health insurance coverage and less continuity of care, used more public clinics and emergency wards, and expressed less trust in their physicians23

Conclusion: Barriers to early diagnosis and appropriate care for prostate cancer among black men were related more to SES than to lack of education or cultural misunderstanding23

28) Gelber et al. Study finds racial disparities in receipt of breast-conserving therapy among women with early-stage breast cancer. Ann Surg Oncol 13 (7): 977-984, 2006



In 2008, research in women with ovarian cancer showed those of higher SES had increased use of surgery and chemotherapy; women in the lowest quartile of SES were more likely to die than those in the highest quartile22

In colorectal cancer, a 2007 study demonstrated that poor, minority and uninsured individuals have reduced access to screening and surgery for colorectal cancer, independent of other patient characteristics.23

It is important to recognize that when policy for cancer control is formulated for diverse ethnicities, in many cases this may present additional challenges not only in terms of socioeconomic status, but also access to health care insurance

Percentage of uninsured Americans by race29: White Americans - 11% Asians – 18% Blacks - 19% Hispanics - 31%

29) Income, Poverty, and Health Insurance Coverage in the United States: 2008, US Census Bureau, US Department of Commerce

Cancer Control Must Start with PreventionCancer Control Must Start with Prevention

The President’s Cancer Panel already has identified tobacco and obesity reduction as important to cancer prevention,30 as has the American Cancer Society.31

Obesity and physical inactivity may account for 25% to 30% of several major cancers, including cancer of the gall bladder, ovaries and pancreas.32

Obese people may have a 19 % higher risk of pancreatic cancer than those with a normal BMI 33

• Obesity may also correlate to the higher pancreatic cancer risk among black Americans.34

30) President’s Cancer Panel, 2007.31) Cancer Statistics 2009: A presentation from the American Cancer Society, American Cancer Society, 2009.32) Vainio H, Bianchini F. IARC handbooks of cancer prevention. Volume 6: Weight control and physical activity. Lyon, France: IARC Press, 2002. 33) Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. British Journal of Cancer 2003; 89(3):519–523.34) AOA Fact Sheets: Obesity in Minority Populations, American Obesity Association, May 2, 2005, http://obesity1.tempdomainname.com/subs/fastfacts/Obesity_Minority_Pop.shtml

Obesity & Smoking Status Obesity & Smoking Status

Race Smoking Status

White 20.3

Black or African 19.0

American Indian or Alaskan Native

27.7

Mexican or Mexican American 12.7

Asian 9.2

2 or more races

Black or African American, white 15.4

Race Inactive Regular Leisure-time Activity

White 37.4 32.1

Black or African 51.0 23.0

American Indian or Alaskan Native 39.8 22.6

Mexican or Mexican American 51.9 22.7

Asian 38.9 30.1

2 or more races

Black or African American, white 42.0 29.9

• Minorities especially Blacks, American Indians and /or Mexicans appear less physically active 35

• In compare to other populations, Asians smoke the least35

35) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2007, US Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics

Obesity in AmericaObesity in America

In comparison to other populations, the Asian population was least overweight or obese 35

Race % Over-weight % Obese

Race 35.1 25.9

White 35.1 25.4

Black or African 35.1 35.1

American Indian or Alaskan Native 34.7 32.4

Mexican or Mexican American 40.3 29.9

Asian 29.2 8.9

2 or more races 35.0 31.2

Black or African American, white 44.4 20.2


Obesity in AmericaObesity in America

African Americans were 1.4 times as likely to be obese as non-Hispanic Caucasians

Hispanic adults were 50% less likely to engage in active physical activity as non-Hispanic Whites

African American women have the highest rates of being overweight or obese compared to other groups in the U.S.

• About four out of five African American women are overweight or obese

73 percent of Mexican American women are overweight or obese compared to 61.6 % of the general female population

Minority women with low income appear to have the greatest likelihood of being overweight Among Mexican American women, age 20 to 74, the rate of overweight is about 13 percent

higher for women living below the poverty line versus above the poverty line


Obesity Increases the Risk of CancerObesity Increases the Risk of Cancer

Obesity and physical inactivity may account for 25 to 30% of several major cancers32

In 2002, about 41,000 new cases of cancer in the US were estimated due to obesity 36

In the US, 14% of death from cancer in men and 20% deaths in women may be due to overweight and obesity37

36) Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415–421. 37) Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New England Journal of

Medicine 2003; 348(17):1625–1638.

Immigrants Face Increasing Risk of Cancer31Immigrants Face Increasing Risk of Cancer31

Cancer Rates for Hispanics in Florida were at least 40% higher than Hispanics in their countries of origin38

Among Cubans and Mexicans in Florida, the risk for colorectal cancer was more than double the risk in Cuba and Mexico. The same was true for lung cancer among Mexican and Puerto Rican women in Florida compared with women in their homelands38

"There is no reason to believe that the people who came to Florida from the Latin countries are different from those who stayed," said Dr. Paulo S. Pinheiro, a researcher in the university's department of epidemiology. "Since there is no genetic difference, if there is a difference it will be in the lifestyles they adopt once they come to the United States." 38

Cancer expert Vilma Cokkinides agrees that unhealthy lifestyle changes increase the cancer risk for Hispanic immigrants. "Immigrants who come and stay longer in the United States start adopting lifestyles that can lead to greater cancer incidents," said Cokkinides, strategic director of risk factor surveillance at the American Cancer Society. "Smoking, diet, lack of physical activity and exposure to certain chemicals tend to lead to a higher risk of cancer.“38

31) Cancer Statistics 2009: A presentation from the American Cancer Society, American Cancer Society, 2009.

38) Pinheiro PS et al. Cancer Incidence in first generation US Hispanics. C Epid Biom Prev 2009; 18(8). August 2009

A Potential Model for Cancer ControlA Potential Model for Cancer Control

The taxonomy modeled by JHU based upon analysis of data from UMass/Johns Hopkins study may help to serve as a potential model against which to assess additional strategies for better control cancer in the USA, embracing and to the benefit all diverse cultures and ethnicities.38

The taxonomy modeled by JHU based upon analysis of data from UMass/Johns Hopkins study may help to serve as a potential model against which to assess additional strategies for better control cancer in the USA, embracing and to the benefit all diverse cultures and ethnicities.38

Comprehensive

Framework forNational

Cancer Control Strategies

Building CapacityBuilding Capacity

Removing BarriersRemoving Barriers

Promoting AdvocacyPromoting Advocacy Developing EvidenceDeveloping Evidence

2839) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis,

1) Removing Barriers1) Removing Barriers

Provide access to early detection and screening via public and private means.

• France: All cancer screening is free to all citizens and public health care workers are measured on their achievement of assigned populations to be screened•Taiwan: Breast care and early detection taught in public school

Ensure that health insurance and providers ensure all patients have access to cancer diagnosis, therapy and care as established by national guidelines.

• Singapore: Highly rated and cost effective health care system where health insurance is an elegantly simple and cost-effective system

Provide access to early detection and screening via public and private means.

• France: All cancer screening is free to all citizens and public health care workers are measured on their achievement of assigned populations to be screened•Taiwan: Breast care and early detection taught in public school

Ensure that health insurance and providers ensure all patients have access to cancer diagnosis, therapy and care as established by national guidelines.

• Singapore: Highly rated and cost effective health care system where health insurance is an elegantly simple and cost-effective system

Barriers:

Out-of-pocket costs

Disparities in access

High cost to payers

Early detection

Reimbursement

39) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis, submitted to The Breast Journal

2) Building Capacity2) Building Capacity

Australia • Emphasis is placed on ensuring adequate numbers of oncology nurses highly skilled in patient and family education, counseling and research.

• Organizations such as the renowned Australia New Zealand Breast Cancer Trials Group ensure that every research protocol is scrutinized by highly skilled consumers, most of whom are cancer survivors themselves.

Japan• The government accepts shared responsibility for licensing of physicians and other health care professionals and approvals of medicines, devices and diagnostics.

• It therefore also limits liability, which further helps keeps liability (and awards for malpractice or harmful results of medical care), health insurance and related legal costs well under control.

Australia • Emphasis is placed on ensuring adequate numbers of oncology nurses highly skilled in patient and family education, counseling and research.

• Organizations such as the renowned Australia New Zealand Breast Cancer Trials Group ensure that every research protocol is scrutinized by highly skilled consumers, most of whom are cancer survivors themselves.

Japan• The government accepts shared responsibility for licensing of physicians and other health care professionals and approvals of medicines, devices and diagnostics.

• It therefore also limits liability, which further helps keeps liability (and awards for malpractice or harmful results of medical care), health insurance and related legal costs well under control.

Capacity

Science and research

Skilled nurses

Research infrastructure

National statistics

Public education


3) Developing Evidence3) Developing Evidence

More funding of basic, ethnically related research alone or in collaboration with other countries with similar ethnic populations create knowledge synergies (and research done outside of US may also be significantly more cost-effective).

Examples such as the GSK Ethnic Research Initiative, or Susan G Komen’s and Gates’ Foundations and many other collaborations in research with industry, government and advocacy are to be commended.

The US has outstanding pathology and other diagnostic/ laboratory capabilities and biomarker technologies and the ability to develop and maintain quality tissue banks for shared research, which may serve not only its own diverse populations, but the world. In turn, this will help to create new jobs, mainly in the US.

More funding of basic, ethnically related research alone or in collaboration with other countries with similar ethnic populations create knowledge synergies (and research done outside of US may also be significantly more cost-effective).

Examples such as the GSK Ethnic Research Initiative, or Susan G Komen’s and Gates’ Foundations and many other collaborations in research with industry, government and advocacy are to be commended.

The US has outstanding pathology and other diagnostic/ laboratory capabilities and biomarker technologies and the ability to develop and maintain quality tissue banks for shared research, which may serve not only its own diverse populations, but the world. In turn, this will help to create new jobs, mainly in the US.

Dimensions

Study of local etiology

Personalized therapy

Developing guidelines

International networks

Local communication


4) Promoting Advocacy4) Promoting Advocacy

Encourage and support ethnically and culturally diverse cancer advocacy initiatives and collaborations. Advocacy also means that the patients are empowered to ensure quality care balanced/quality of life. Taiwan: National coalitions form that allow local, special interest and other smaller, diverse advocacy groups obtain a bigger voice at the national level.

Quebec: Cancer specialists organized themselves and taught primary care physicians resulting in as good as, if not better, ongoing cancer care.

In the US, the Fred Hutchinson Cancer Institute has translated guidelines for the Breast Health Global Initiative in many different languages of the world.

Cancer advocacy groups should evaluate how they may better serve culturally and ethnically diverse patient groups.

Encourage and support ethnically and culturally diverse cancer advocacy initiatives and collaborations. Advocacy also means that the patients are empowered to ensure quality care balanced/quality of life. Taiwan: National coalitions form that allow local, special interest and other smaller, diverse advocacy groups obtain a bigger voice at the national level.

Quebec: Cancer specialists organized themselves and taught primary care physicians resulting in as good as, if not better, ongoing cancer care.

In the US, the Fred Hutchinson Cancer Institute has translated guidelines for the Breast Health Global Initiative in many different languages of the world.

Cancer advocacy groups should evaluate how they may better serve culturally and ethnically diverse patient groups.


Advocacy

Patient empowerment

Managing survivorship

Quality of life

Metastic disease

Organized advocacy

THE GOOD NEWS…THE GOOD NEWS…

• Need for new policies and practices to be developed to better control cancer in America’s increasingly culturally and ethnically diverse nation

• America does not have to learn on its own• It has much to learn from the rest of the world as the

world may learn from it• As a result, when the US succeeds in achieving better

control of cancer across its rich and diverse population; everyone - not only in the US, but in the world - will benefit.

• Need for new policies and practices to be developed to better control cancer in America’s increasingly culturally and ethnically diverse nation

• America does not have to learn on its own• It has much to learn from the rest of the world as the

world may learn from it• As a result, when the US succeeds in achieving better

control of cancer across its rich and diverse population; everyone - not only in the US, but in the world - will benefit.

www.innovara.com

http://www.innovara.com/

US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)

Health & Medicine

Transcript of US Ethnicity and Cancer, Learning from the World (B Blauvelt Innovara)