Cancer data put spotlight on health disparities

Washington -- Alex, 11 years old, and Justin, 10, have cancer, as does 7-year-old Jen.

Unlike Jen, whose leukemia was found early, the boys' cancers were diagnosed when they were on death's door, said filmmaker Julia Reichert, who followed the children's progress over five years as she and her husband filmed a documentary on childhood cancer, A Lion in the House.

Alex and Justin are black and Jen is white. The boys could well typify the black experience with cancer. Black men and women have a cancer death rate about 35% higher than the rate for whites. Failure to be properly diagnosed early enough for effective treatment is one of the reasons.

Alex, for example, had been diagnosed with asthma until the giant tumor on his windpipe was discovered.

Reichert and her husband, Steven Bognar, whose own daughter survived cancer, decided a film on childhood cancer could provide a window on the "whole cancer journey." They previewed a portion of their film at the 9th Biennial Symposium on Minorities, the Medically Underserved and Cancer, in Washington, D.C., and their six-hour film is scheduled to be aired next year on PBS.

The toll

Cancer statistics for adults in minority groups raise questions about the roles played by genetics, treatment and other factors. For example, while black women have a lower risk of developing breast cancer than white women, they are more likely to die from it, according to the American Cancer Society.

Between 1996 and 2000, black men were 60% more likely than white men to get prostate cancer and more than twice as likely to die from it. And blacks have a lower five-year survival rate for all cancers and at all stages of diagnosis. Blacks are more likely to be diagnosed at a later stage of cancer when survival rates are lower.

Other groups also fare poorly. Cervical cancer incidence in Hispanic women has been consistently higher at all ages than for other women. American Indians and Alaska natives have the poorest survival from all cancers combined in comparison with all other racial and ethnic groups.

Francis Collins, MD, PhD, director of the National Human Genome Research Institute, plumbed his scientific background to determine how disparities arise and how they might be eliminated. "I'm going to argue that genetics is a part of the solution because it gives us the chance to shine a bright light into some of the areas of our current ignorance."

Genetics will foster an understanding of why certain diseases strike certain people, he said. "Over the next four to five years, we should be able to identify genes that indicate risk for common cancers," said Dr. Collins. "Once done, it will provide tools to predict who is at high risk and advise people on risk factors."

This is already being done for colon, breast and ovarian cancers, he noted. And the National Genome Research Institute and Howard University, Washington, D.C., are collaborating to identify black families in which four or more men younger than 65 have prostate cancer

But "you don't really understand cancer if you don't understand it as a human condition," said Harold P. Freeman, MD, director of the National Cancer Institute's Center to Reduce Cancer Health Disparities. Economic, social, cultural, political and environmental factors come into play, said Dr. Freeman, who chaired hearings for the President's Cancer Panel.