• Carrie Printz

ASCO Plan to Reduce US Cancer Disparities

Elderly and minorities will be most affected by cancer in the future

Initiatives are clearly needed to address the needs of these rapidly growing populations of patients.—Benjamin Smith, MD

During the next 20 years, the number of cancer cases in older and minority Americans is expected to increase at a much higher rate than in other populations —a 67% and 100% increase, respectively, compared with a 31% increase for whites, according to a study published in the Journal of Clinical Oncology.1 In hard numbers, of a total 2.3 million diagnosed cancer cases in 2030, 1.6 million will be adults older than age 65 years—or 70% of the 2.3 million total—and 660,000 will be nonwhite individuals —28% of the 2.3 million total.

“Initiatives are clearly needed to address the needs of these rapidly growing populations of patients,” says the study's senior author Benjamin Smith, MD, adjunct assistant professor of radiation oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

The American Society of Clinical Oncology (ASCO) recently proposed a set of recommendations to help reduce these disparities. According to ASCO President Richard Schilsky, MD, “We need to practice more efficiently, collaborate better with primary care physicians, think about diversity diversity in the oncology workforce, and provide incentives for physicians to work in oncology.”

ASCO is linking with several other professional organizations to put some of their plans into action, says Derek Raghavan, MD, PhD, co-chair of ASCO's Health Disparities Advisory Group and director of the Cleveland Clinic Taussig Cancer Center in Cleveland, Ohio. “We've made so much progress in the field with the advent of the molecular revolution, but the underserved are not benefitting,” Dr. Raghavan says.

Lack of health insurance and access to medical care continue to be among the biggest contributors to the problem, with more than 1 of every 5 African Americans and more than 1 of every 3 Latinos uninsured, according to ASCO. Programs that improve access to care can significantly reduce disparities, notes Otis Brawley, MD, chief medical officer of the American Cancer Society and co-chair of ASCO's Health Disparities Advisory Group. He cites a study conducted among female breast-cancer patients who were treated at military hospitals.2 In the study, African American women treated in military healthcare facilities had a lower mortality rate (24.77%) than that of African American women represented in the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (34.2%). In the study, the mortality rates for white women were 18.08% for those treated in military facilities and 18.4% for white women in SEER. The researchers concluded that although ready access to medical facilities and a full complement of treatment options improve survival rates for African American women, a significant, unexplained, survival difference still exists compared with white women.

Dr. Brawley points to another study that found that in urban Atlanta today, 7.5%of African American women and 1.5% of white women had not undergone surgery to remove their tumor within 1 year after they received a breast cancer diagnosis —a surgery the medical community has used for more than 100 years.“People are disenfranchised, scared, and having difficulty accessing care,” he says. In response to these issues, ASCO's “road map” for helping to reduce disparities includes the following recommendations:

  • Increase prioritization of public and private research on cancer-care disparities. Even when underserved populations are insured, gaps still exist in the quality of care received by minorities. ASCO is supporting research in this area through the establishment of a Young Investigator Award in health disparities research. The society also plans to continue integrating health-disparities research into its annual meeting's scientific sessions.

  • Diversify clinical trials. Researchers and physicians who treat racially and ethnically diverse populations must participate in clinical-trial recruitment. Improving access means educating physicians and patients about these trials, developing eligibility criteria that ensure participation by minorities, and addressing logistical issues such as transportation and child care. Medically underserved groups' participation in clinical trials will expand these individuals' available treatment options and also increase the likelihood that research results will apply to all cancer patients.

  • Diversify and train the oncology workforce by increasing the recruitment of minorities in the healthcare field. Currently, only 12% of US medical students are African American, Latino, or Native American, even though these groups compose 25% of the US population. Experts add that minority physicians are more likely to practice in underserved, urban communities. Few clinical oncology programs target minority students, and improved recruitment efforts could increase the number of oncologists who provide care tomedically underserved populations. In partnership with the Susan G. Komen for the Cure Foundation, ASCO has launched the Diversity in Oncology Initiative, which is designed to recruit and retain diverse clinical oncologists. They recently announced the first awards, which provide $50, 000 each to 3 young oncologists. The awards cover research, travel, and a loan-repayment program for minority medical students and residents who agree to practice in a medically underserved region.

  • Enhance patient involvement in their own care. ASCO is attempting to define patient-centered care that is culturally and linguistically appropriate by developing templates for treatment plans, summaries, and follow-up survivorship plans. These plans will help physicians improve documentation and communication while enabling patients to manage their care.

ASCO leaders are confident that these initiatives will begin to address disparities in cancer diagnosis and treatment. Says Dr. Raghavan, “This is a national emergency…. If we can catch cancer early enough, we can treat it.”

Key Points

  • The number of minority and older cancer patients will increase dramatically during the next 20 years.

  • Even when insurance and access to medical care are comparable, minorities still have higher mortality rates than whites.

  • ASCO, in partnership with other organizations, recently announced specific initiatives to help address these disparities, including increasing disparities research, diversifying patients in clinical trials, diversifying and increasing recruitment into the oncology workforce, and enhancing patients' involvement in their own care.


1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–2765.

2. Wojcik BE, Spinks MK, Optenberg SA. Breast carcinoma survival analysis for African American and white women in an equal-access health care system. Cancer. 1998;82:1310–1318.

3. Lund MJ, Brawley OP, Ward KC, Young JL, Gabram SS, Eley JW. Parity and disparity in first course treatment of invasive breast cancer. Breast Cancer Res Treat. 2008;109:545–557.

Booklet Explains Cancer Care Costs

A new booklet from ASCO helps doctors and patients communicate about the costs associated with cancer care. This booklet includes ways for patients to talk with their physicians about managing costs, a summary of costs associated with treatment, a list of financial resources for patients in need of assistance, how to organize financial paperwork, and an explanation of different types of insurance. It is available online at

ASCO developed the booklet because cancer-care costs are increasing at a rate of 15% per year, and the newest cancer drugs can cost thousands of dollars annually. ASCO's Cost of Cancer Care Task Force, made up of leading oncologists and patient advocates, also is developing guidance on actions physicians can take to address this cost-of-care problem and is recommending potential policy solutions.


TITLE: RADIANT: A study of Tarceva after surgery with or without adjuvant chemotherapy in nonsmall cell lung cancer (NSCLC) patients who have epidermal growth factor receptor (EGFR)-positive tumors


CONTACT: OSIP Medical Information, (800) 572-1932, ext. 7821,; Tarceva Medical Information, (303) 546-7821

SUMMARY RADIANT is a phase 3 study that is evaluating the effectiveness of erlotinib (Tarceva) versus placebo (sugar pill) after complete surgical removal of a tumor with or without chemotherapy after surgery in stage IB-IIIA NSCLC patients. The primary outcome measure is disease-free survival for 3 years; the secondary outcome measure is overall survival for 3 years.

ELIGIBILITY Patients must have tissue from surgery that has been shown to be EGFR-positive by certain tests, have had up to 4 cycles of chemotherapy after surgery, have had complete removal of the tumor by surgery, be able to start the drug 6 months from the day of surgery for patients who are to receive chemotherapy and 3 months from the day of surgery for those who are not to receive chemotherapy, have a confirmed diagnosis of stage IB-IIIA NSCLC, and be accessible for follow-up visits.

ACS Annual Cancer Statistics Show Steady Decline in Death Rates

According to the American Cancer Society (ACS) in its “Cancer Statistics, 2009” report, approximately 650, 000 cancer deaths were avoided or delayed during the 15 years after death rates began to decline in the early 1990s.1

The overall cancer death rate in men decreased by 19.2% between 1990 and 2005, largely because of reductions in lung, prostate, and colorectal cancers. In women, the death rate decreased by 11.4% between 1991 and 2005, driven by reductions in breast and colorectal cancers. “Because the death rate continues to drop, it means that in recent years, about 100, 000 people each year who would have died are living to celebrate another birthday,” ACS Chief Executive Officer John R. Seffrin, PhD, noted in an ACS news release.

ACS also publishes a consumer-friendly companion report, “Cancer Facts && Figures,” (available online at, which annually highlights a special section on a cancer-related topic. This year's special section focuses on multiple primary cancers. Among the report's estimates are:

  • There will be 1, 479, 350 new cancer cases (766, 130 men and 713, 220 in women) and 562, 340 cancer deaths (292, 540 among men and 269, 800 among women) in 2009.

  • Lung, prostate, breast, and colon cancers continue to be the most common fatal cancers, accounting for half of the total deaths among men and women.

  • Among men in 2009, cancers of the prostate, lung, and colon will account for half of all newly diagnosed cancers. Prostate cancer will account for about 25% (192, 280) of cancer cases in men. About 9 in 10 of these new cases are expected to be diagnosed at local or regional stages, for which the 5-year relative survival approaches 100%.

  • In women, the 3 most commonly diagnosed cancers in 2009 will be breast, lung, and colon—accounting for 51% of all cases in women. Breast cancer will account for 27% (192, 370) of all new cancer cases in women.


1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer Statistics, 2009. CA Cancer J Clin. 2009 June 9. [Epub ahead of print].

New Microscope Can Detect Cancer in 3-D

A new microscope that can portray cells in 3 dimensions (3-D) may help advance the field of early cancer detection. The microscope, called Cell-CT, was developed by University of Washington (UW) researchers in collaboration with VisionGate, Inc, in Gig Harbor, Washington.

Because clinicians today use 2-dimensional (2-D) pictures to assess cells, the new technology could lead to important advances, according to Eric Seibel, PhD, research associate professor of mechanical engineering at UW and 1 of the developers of the microscope. “It's a lot easier to spot a misshapen cell if you can see it from all sides,” Dr. Seibel says in a UW news release. “A 2-D representation of a 3-D object is never perfectly accurate—imagine trying to get an exact picture of the moon [by] seeing only 1 side.”

In the Cell-CT microscope, each cell is imbedded in a special gel inside a glass tube. The tube rotates in front of a camera that takes many pictures per rotation. Hundreds of pictures are then assembled to form a 3-D image that can be viewed on a computer screen.

This technology will also facilitate the translation of research to clinical practice. Pathologists today are still using the same cell stain for cancer diagnosis that was invented and used in the 1700s. They do not use any of the newer, fluorescent, molecular dyes that produce the detailed cell pictures shown in biology journals, Dr. Seibel notes. Because the Cell-CT microscope can use both traditional and fluorescent stains, some of these more sophisticated research techniques can now be put into clinical use, he adds.

Dr. Seibel and colleagues have shown in studies that pathologists who used the 3-D technology detected cancer with one-third the error rate compared with those who used a traditional microscope. Pathologist who used the newer 3-D technology were also able to discover precancerous cells.