The questions have long dogged physician-scientists: Why are certain blood cancers more prevalent among African Americans? Is it genes or environment? And why are their outcomes generally poorer even when they receive the same treatment?
“It’s a very complicated picture, and there isn’t one simple answer,” explains Namrata Chandhok, M.D., a hematologist/oncologist at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. “Biology is just one key factor, but there are other important issues such as health behaviors and structural barriers to care that also come into play.”
However, Dr. Chandhok is quick to add that “every study, every paper brings us closer to a better understanding.”
Recent studies shed light on disparities
One study explains why a subtype of a rare blood cancer — acute myeloid leukemia (AML) — proves more deadly among Black patients, even when they receive the same treatment as white patients. Another, published in the journal Blood last year, reveals that cutting-edge treatment for multiple myeloma results in equal or higher survival rates for African Americans suffering from this common blood cancer. The two may seem to contradict each other, but they actually don’t.
The American Society of Hematology has noted that there are “significant” racial/ethnic disparities in incidence and survival for patients diagnosed with hematologic malignancies. (This is also true for most solid tumors, according to the American Cancer Society.)
We’re only beginning to understand why. A research team looked at records of more than 800 people diagnosed with AML in Chicago. It found that those who lived in more impoverished neighborhoods had a greater risk of dying from the disease. Among Blacks, the risk was 48% higher; among Hispanics, 20%. Data on younger AML patients showed a similar disparity in outcomes between the two races. Young Black AML patients had a 27% greater risk of dying than their white counterparts.
This doesn’t surprise Dr. Chandhok. “We have a systemic problem,” she says. “It’s often about having less access to health care and of not being diagnosed correctly or early enough.”
Biology still plays a role
However, geographic and lifestyle factors aren’t the only culprits, Dr. Chandhok adds. She notes that a complicated interplay of both environment and biology causes many cancers. The AML study bears this out as well.
Looking back at 10-year data of AML patients, this study showed that mutations generally thought to be “good risk,” with a higher chance of survival or cure, did not improve the outcomes of black patients as much as they improved outcomes of white patients. This points to the role of genetic differences in patients from different racial backgrounds.
Compounding these differences is the fact that African Americans “are underrepresented in clinical trials that lead to new therapies,” Dr. Chandhok says. So, extensive scientific “data about everything from the correct dosage amount to how a racial or ethnic group will react to certain therapies are less representative of Black patients than their white counterparts.”
On the multiple myeloma front
African Americans make up about 20% of the cases of this common hematologic cancer. But as with other cancers, their survival rate is also less promising because African Americans are less likely to undergo stem cell transplants, which is the standard of care for most patients. Yet, when they receive the right treatment — as the Veterans Administration data published in the journal Blood shows — outcome differences are eliminated.
Dr. Chandhok believes proper vigilance, improving access to care, and exploring better representation of minority populations in clinical trials will go a long way in improving outcomes of blood cancers among different racial groups. She says many of her patients are referred by primary care physicians who discover problems during blood tests, which underscores the importance of routine well-care. Physicals and regular doctor’s visits can help detect blood cancer before a patient begins to feel the telltale symptoms of fatigue, swollen glands, rash-like skin changes, fever, and weight loss.
“Know your body,” she says. “Know your family history. Having good information [through routine visits and bloodwork] and proper monitoring can go a long way.”
Ana Veciana-Suarez, Guest Columnist
Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.
COVID-19 has shone a bright light on the expansive impact of healthcare disparities. From access to healthcare to representation in clinical studies, physicians agree that minorities are undercounted.