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Advancing Health Equity to Reduce Cancer Health Disparities

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 24224

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Special Issue Editors

Prof. Dr. Shailesh Singh

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Guest Editor

1. Department of Microbiology, Immunology, and Biochemistry, Morehouse School of Medicine, Atlanta, GA 30310, USA
2. Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
Interests: cancer progression and metastasis; tumor immunobiology; cancer health disparity
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Rajesh Singh

E-Mail Website
Guest Editor

1. Department of Microbiology, Immunology, and Biochemistry, Morehouse School of Medicine, Atlanta, GA 30310, USA
2. Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
Interests: targeted therapy; nano-therapy; nano-delivery; chemokine; combination therapy; prostate cancer; pancreatic cancer; liver cancer; ovarian cancer; breast cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Health is a fundamental human right. The preamble of the World Health Organization (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. This Special Issue aims to bring the scientific community into the discussion to achieve cancer health equity by addressing the racial gap in cancer incidence, disease, and therapeutic outcome, which can be addressed at social and behavioral, genetic, health informatics, and precision medicine.

Achieving cancer health equity via social and therapeutic interventions is required to address the racial gap in cancer incidence, disease aggressiveness, clinical and therapeutic outcome, and overall survival. Hence, we invite an article focused on cancer health disparity to achieve cancer health equity to reduce the racial gap in cancer by interventions at community and clinics by identifying specific molecular and cellular targets, and SES impacting these targets.

We are pleased to invite you to submit your work addressing cancer disparity to gain cancer health equity. This Special Issue aims to publish original research articles, reviews, and editorials focused on basic, translational, and clinical studies on all tumor types addressing disparity. Research areas may include (but are not limited to) the following: socioeconomic status (SES) and cancer, addressing cancer disparity using health informatics, molecular basis of cancer disparity, racial differences in tumor immunity and cancer disparity, transcriptomes and cancer disparity, and association of SES with a cellular and molecular footprint of cancer impacting disease and therapeutic outcomes.

We look forward to receiving your contributions.

Prof. Dr. Shailesh Singh
Dr. Rajesh Singh
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

social determinants of cancer
molecular basis of disparity
racial differences in the immunological landscape
racial differences in treatment and disease outcome
equity lens
cancer prevention
precision medicine and health informatics

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Published Papers (10 papers)

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Research

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19 pages, 309 KiB

Open AccessArticle

TCGA Expression Analyses of 10 Carcinoma Types Reveal Clinically Significant Racial Differences

by Brian Lei, Xinyin Jiang and Anjana Saxena

Cancers 2023, 15(10), 2695; https://doi.org/10.3390/cancers15102695 - 10 May 2023

Cited by 3 | Viewed by 2241

Abstract

Epidemiological studies reveal disparities in cancer incidence and outcome rates between racial groups in the United States. In our study, we investigated molecular differences between racial groups in 10 carcinoma types. We used publicly available data from The Cancer Genome Atlas to identify patterns of differential gene expression in tumor samples obtained from 4112 White, Black/African American, and Asian patients. We identified race-dependent expression of numerous genes whose mRNA transcript levels were significantly correlated with patients’ survival. Only a small subset of these genes was differentially expressed in multiple carcinomas, including genes involved in cell cycle progression such as CCNB1, CCNE1, CCNE2, and FOXM1. In contrast, most other genes, such as transcriptional factor ETS1 and apoptotic gene BAK1, were differentially expressed and clinically significant only in specific cancer types. Our analyses also revealed race-dependent, cancer-specific regulation of biological pathways. Importantly, homology-directed repair and ERBB4-mediated nuclear signaling were both upregulated in Black samples compared to White samples in four carcinoma types. This large-scale pan-cancer study refines our understanding of the cancer health disparity and can help inform the use of novel biomarkers in clinical settings and the future development of precision therapies. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

28 pages, 9828 KiB

Open AccessArticle

Lipidomic Profiling Reveals Biological Differences between Tumors of Self-Identified African Americans and Non-Hispanic Whites with Cancer

by April E. Boyd, Pamela J. Grizzard, Katherine Hylton Rorie and Santiago Lima

Cancers 2023, 15(8), 2238; https://doi.org/10.3390/cancers15082238 - 11 Apr 2023

Cited by 2 | Viewed by 1853

Abstract

In the US, the incidence and mortality of many cancers are disproportionately higher in African Americans (AA). Yet, AA remain poorly represented in molecular studies investigating the roles that biological factors might play in the development, progression, and outcomes of many cancers. Given that sphingolipids, key components of mammalian cellular membranes, have well-established roles in the etiology of cancer progression, malignancy, and responses to therapy, we conducted a robust mass spectrometry analysis of sphingolipids in normal adjacent uninvolved tissues and tumors of self-identified AA and non-Hispanic White (NHW) males with cancers of the lung, colon, liver, and head and neck and of self-identified AA and NHW females with endometrial cancer. In these cancers, AA have worse outcomes than NHW. The goal of our study was to identify biological candidates to be evaluated in future preclinical studies targeting race-specific alterations in the cancers of AA. We have identified that various sphingolipids are altered in race-specific patterns, but more importantly, the ratios of 24- to 16-carbon fatty acyl chain-length ceramides and glucosylceramides are higher in the tumors of AA. As there is evidence that ceramides with 24-carbon fatty acid chain length promote cellular survival and proliferation, whereas 16-carbon chain length promote apoptosis, these results provide important support for future studies tailored to evaluate the potential roles these differences may play in the outcomes of AA with cancer. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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12 pages, 1401 KiB

Open AccessArticle

Pancreatic Cancer Incidence Trends by Race, Ethnicity, Age and Sex in the United States: A Population-Based Study, 2000–2018

by Jamil S. Samaan, Yazan Abboud, Janice Oh, Yi Jiang, Rabindra Watson, Kenneth Park, Quin Liu, Katelyn Atkins, Andrew Hendifar, Jun Gong, Arsen Osipov, Debiao Li, Nicholas N. Nissen, Stephen J. Pandol, Simon K. Lo and Srinivas Gaddam

Cancers 2023, 15(3), 870; https://doi.org/10.3390/cancers15030870 - 31 Jan 2023

Cited by 14 | Viewed by 3177

Abstract

Background and aims: Pancreatic cancer (PC) incidence is increasing at a greater rate in young women compared to young men. We performed a race- and ethnicity-specific evaluation of incidence trends in subgroups stratified by age and sex to investigate the association of race and ethnicity with these trends. Methods: Age-adjusted PC incidence rates (IR) from the years 2000 to 2018 were obtained from the SEER 21 database. Non-Hispanic White (White), Non-Hispanic Black (Black) and Hispanic patients were included. Age categories included older (ages ≥ 55) and younger (ages < 55) adults. Time-trends were described as annual percentage change (APC) and average APC (AAPC). Results: Younger White [AAPC difference = 0.73, p = 0.01)], Black [AAPC difference = 1.96, p = 0.01)] and Hispanic [AAPC difference = 1.55, p = 0.011)] women experienced a greater rate of increase in IR compared to their counterpart men. Younger Hispanic women experienced a greater rate of increase in IR compared to younger Black women [AAPC difference = −1.28, p = 0.028)] and younger White women [AAPC difference = −1.35, p = 0.011)]. Conclusion: Younger women of all races and ethnicities experienced a greater rate of increase in PC IR compared to their counterpart men; however, younger Hispanic and Black women experienced a disproportionately greater increase. Hispanic women experienced a greater rate of increase in IR compared to younger Black and White women. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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19 pages, 4441 KiB

Open AccessArticle

Is the Social Gradient in Net Survival Observed in France the Result of Inequalities in Cancer-Specific Mortality or Inequalities in General Mortality?

by Laure Tron, Laurent Remontet, Mathieu Fauvernier, Bernard Rachet, Aurélien Belot, Ludivine Launay, Ophélie Merville, Florence Molinié, Olivier Dejardin, Francim Group and Guy Launoy

Cancers 2023, 15(3), 659; https://doi.org/10.3390/cancers15030659 - 20 Jan 2023

Viewed by 1834

Abstract

Background: In cancer net survival analyses, if life tables (LT) are not stratified based on socio-demographic characteristics, then the social gradient in mortality in the general population is ignored. Consequently, the social gradient estimated on cancer-related excess mortality might be inaccurate. We aimed to evaluate whether the social gradient in cancer net survival observed in France could be attributable to inaccurate LT. Methods: Deprivation-specific LT were simulated, applying the social gradient in the background mortality due to external sources to the original French LT. Cancer registries’ data from a previous French study were re-analyzed using the simulated LT. Deprivation was assessed according to the European Deprivation Index (EDI). Net survival was estimated by the Pohar–Perme method and flexible excess mortality hazard models by using multidimensional penalized splines. Results: A reduction in net survival among patients living in the most-deprived areas was attenuated with simulated LT, but trends in the social gradient remained, except for prostate cancer, for which the social gradient reversed. Flexible modelling additionally showed a loss of effect of EDI upon the excess mortality hazard of esophagus, bladder and kidney cancers in men and bladder cancer in women using simulated LT. Conclusions: For most cancers the results were similar using simulated LT. However, inconsistent results, particularly for prostate cancer, highlight the need for deprivation-specific LT in order to produce accurate results. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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17 pages, 4163 KiB

Open AccessArticle

Health Burdens and SES in Alabama: Using Geographic Information System to Examine Prostate Cancer Health Disparity

by Seela Aladuwaka, Ram Alagan, Rajesh Singh and Manoj Mishra

Cancers 2022, 14(19), 4824; https://doi.org/10.3390/cancers14194824 - 2 Oct 2022

Cited by 10 | Viewed by 2819

Abstract

Socioeconomic disparities influence the risk of many diseases, including cancer. The cancer rate in Alabama is high, and the state has one of the highest rates of prostate cancer in the USA. Alabama’s counties are embedded with socioeconomic disparities, politics, race, ethnicity, and oppression, among which social equity and socioeconomic status (SES) been closely associated with prostate cancer. The Geographic Information System (GIS) has become a valuable technology in understanding public health in many applications, including cancer. This study integrates Alabama’s county-level prostate cancer incidence and mortality and its association with socioeconomic and health disparities. We conducted robust data mining from several data sources such as the Alabama State Cancer Profile data, Alabama Department of Health, American Cancer Society, Center for Disease Control, and National Cancer Institute. The research method is the Geographic Information System (GIS), and we employed prostate cancer data within GIS to understand Alabama’s prostate cancer prevalence regarding SES. The GIS analysis indicated an apparent socioeconomic disparity between the Black Belt and Non-Black Belt counties of Alabama. The Black Belt counties’ poverty rate is also remarkably higher than non-Black Belt counties. In addition, we analyzed the median household income by race. Our analysis demonstrates that the Asian background population in the state earned the highest median income compared to non-Hispanic whites and the African American population. Furthermore, the data revealed that the preexisting condition of diabetes and obesity is closely associated with prostate cancer. The GIS analysis suggests that prostate cancer incidence and mortality disparities are strongly related to SES. In addition, the preexisting condition of obesity and diabetes adds to prostate cancer incidences. Poverty also reflects inequalities in education, income, and healthcare facilities, particularly among African Americans, contributing to Alabama’s health burden of prostate cancer. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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15 pages, 1272 KiB

Open AccessArticle

No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks’ Outcome?

by Yohan Fayet, Christine Chevreau, Gauthier Decanter, Cécile Dalban, Pierre Meeus, Sébastien Carrère, Leila Haddag-Miliani, François Le Loarer, Sylvain Causeret, Daniel Orbach, Michelle Kind, Louis-Romée Le Nail, Gwenaël Ferron, Hélène Labrosse, Loïc Chaigneau, François Bertucci, Jean-Christophe Ruzic, Valérie Le Brun Ly, Fadila Farsi, Emmanuelle Bompas, Sabine Noal, Aurore Vozy, Agnes Ducoulombier, Clément Bonnet, Sylvie Chabaud, Françoise Ducimetière, Camille Tlemsani, Mickaël Ropars, Olivier Collard, Paul Michelin, Justine Gantzer, Pascale Dubray-Longeras, Maria Rios, Pauline Soibinet, Axel Le Cesne, Florence Duffaud, Marie Karanian, François Gouin, Raphaël Tétreau, Charles Honoré, Jean-Michel Coindre, Isabelle Ray-Coquard, Sylvie Bonvalot and Jean-Yves Blay Show full author list Hide full author list

Cancers 2022, 14(11), 2620; https://doi.org/10.3390/cancers14112620 - 25 May 2022

Cited by 4 | Viewed by 2340

Abstract

The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients’ survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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14 pages, 2364 KiB

Open AccessArticle

Modifiers of and Disparities in Palliative and Supportive Care Timing and Utilization among Neurosurgical Patients with Malignant Central Nervous System Tumors

by Michael Chuwei Jin, Gary Hsin, John Ratliff, Reena Thomas, Corinna Clio Zygourakis, Gordon Li and Adela Wu

Cancers 2022, 14(10), 2567; https://doi.org/10.3390/cancers14102567 - 23 May 2022

Cited by 5 | Viewed by 2192

Abstract

Patients with primary or secondary central nervous system (CNS) malignancies benefit from utilization of palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines propose early initiation of PC for patients with advanced cancers. We analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities in access to and utilization of supportive services. We introduce a novel construct, “provider patient racial diversity index” (provider pRDI), which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider’s patient demographics and suggest a provider’s cultural sensitivity and exposure to diversity. Our analysis demonstrates low rates of PC, home health, and social work services among racial minority patients. Notably, Hispanic patients had low likelihood of engaging with all three categories of supportive services. However, patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses. This study suggests that prospective studies that examine potential interventions at the provider level, including diversity training, are needed. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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12 pages, 751 KiB

Open AccessArticle

Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014–2020

by Christopher T. Su, Christine M. Veenstra and Minal R. Patel

Cancers 2022, 14(7), 1605; https://doi.org/10.3390/cancers14071605 - 22 Mar 2022

Cited by 4 | Viewed by 2168

Abstract

Introduction: Important differences exist between the presentation, treatment, and survivorship of patients and survivors with blood cancers. Furthermore, existing research in financial toxicity has not fully addressed the relationship between medical care utilization and patient-reported outcomes of financial barriers and distress. We answered these questions by using a nationally representative survey. Methods: Respondents with blood cancers and solid tumors from the National Health Interview Survey were identified (2014–2020). We identified 23 survey questions as study outcomes and grouped them into three domains of medical care utilization, financial barriers to care, and financial distress. Associations between the three domains and associations of study outcomes between cancer types were examined using weighted univariate analyses and multivariable linear and logistic regressions. Results: The final study group consisted of 6248 respondents with solid tumors and 398 with blood cancers (diagnosed ≤ 5 years). Across all respondents with cancer, higher medical care utilization is generally associated with increased financial barriers to care. Compared to respondents with solid tumors, respondents with blood cancers had a higher level of medical care utilization (β = 0.36, p = 0.02), a lower level of financial barriers to care (β = −0.19, p < 0.0001), and a higher level of financial distress in affording care (β = 0.64, p = 0.03). Conclusions: Patients and survivors with blood cancers and solid tumors demonstrate divergent patterns in care utilization, financial barriers, and financial distress. Future research and interventions on financial toxicity should be tailored for individual cancer groups, recognizing the differences in medical care utilization, which affect the experienced financial barriers. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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Review

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15 pages, 669 KiB

Open AccessReview

The Interplay between Structural Inequality, Allostatic Load, Inflammation, and Cancer in Black Americans: A Narrative Review

by Ashanda R. Esdaille, Nelson Kevin Kuete, Vivian Ifunanya Anyaeche, Ecem Kalemoglu and Omer Kucuk

Cancers 2024, 16(17), 3023; https://doi.org/10.3390/cancers16173023 - 30 Aug 2024

Viewed by 948

Abstract

The impact of racial healthcare disparities has been well documented. Adverse social determinants of health, such as poverty, inadequate housing, and limited access to healthcare, are intricately linked to these disparities and negative health outcomes, highlighting the profound impact that social and economic factors have on individuals’ overall well-being. Recent evidence underscores the role of residential location on individual health outcomes. Despite the importance of a healthy lifestyle, regular physical activity, balanced nutrition, and stress management for favorable health outcomes, individuals living in socioeconomically disadvantaged areas may face obstacles in achieving these practices. Adverse living conditions, environmental factors, and systemic biases against Black Americans perpetuate allostatic load. This, compounded by decreased physical activity and limited healthy food options, may contribute to increased oxidative stress and inflammation, fundamental drivers of morbidities such as cardiovascular disease and cancer. Herein, we perform a narrative review of associations between healthcare disparities, chronic stress, allostatic load, inflammation, and cancer in Black Americans, and we discuss potential mechanisms and solutions. Additional research is warranted in the very important area of cancer disparities. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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16 pages, 637 KiB

Open AccessReview

Social and Biological Determinants in Lung Cancer Disparity

by Briana A. Brock, Hina Mir, Eric L. Flenaugh, Gabriela Oprea-Ilies, Rajesh Singh and Shailesh Singh

Cancers 2024, 16(3), 612; https://doi.org/10.3390/cancers16030612 - 31 Jan 2024

Cited by 3 | Viewed by 2996

Abstract

Lung cancer remains a leading cause of death in the United States and globally, despite progress in treatment and screening efforts. While mortality rates have decreased in recent years, long-term survival of patients with lung cancer continues to be a challenge. Notably, African American (AA) men experience significant disparities in lung cancer compared to European Americans (EA) in terms of incidence, treatment, and survival. Previous studies have explored factors such as smoking patterns and complex social determinants, including socioeconomic status, personal beliefs, and systemic racism, indicating their role in these disparities. In addition to social factors, emerging evidence points to variations in tumor biology, immunity, and comorbid conditions contributing to racial disparities in this disease. This review emphasizes differences in smoking patterns, screening, and early detection and the intricate interplay of social, biological, and environmental conditions that make African Americans more susceptible to developing lung cancer and experiencing poorer outcomes. Full article

(This article belongs to the Special Issue Advancing Health Equity to Reduce Cancer Health Disparities)

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