By Sue Rochman
In their own words, six experts discuss how and why cancer disparities occur—and what we can do about them
By Sue Rochman
Interest in health disparities has taken root in the cancer field. From the lab to the legislature, pursuing ways to reduce cancer incidence and deaths among minority and underserved populations is now central to the work of many scientists, academics, epidemiologists, health care providers, advocates and elected officials.
For many years, addressing health disparities typically meant focusing on ways to increase the number of insured people in the U.S. But as research has made clear, insurance is not enough. There are many factors that interweave and overlap in the lives of minority and underserved populations that can prevent them from getting the screening tests, like colonoscopy, that can prevent cancer, or those, like mammography, that can find the disease early. And even when people do get screened, there may be additional barriers that keep women and men from getting the follow-up care and medical treatments that can reduce cancer deaths.
CR spoke with six researchers and health care providers who each have a unique window into how and why cancer disparities occur. By looking at this national problem through their eyes, we have the opportunity to better understand the people behind the statistics—as well as the types of programs that need to be implemented, the research that needs to take place and the societal and cultural changes that need to occur if cancer disparities are to be eliminated.
Electra D. Paskett
Epidemiologist, Ohio State University, Columbus
Focus: Rural and Appalachian disparities
The National Institutes of Health has established eight Centers for Population Health and Health Disparities to support interdisciplinary research aimed at reducing differences in health outcomes, access and care. My current work on rural women and cervical cancer is part of this effort. We use a unique framework for exploring cancer health disparities. We start from the perspective that a disparity doesn’t occur just because an individual is poor or can’t access health care; there are a whole host of other contributing factors that need to be addressed.
Right now, I’m conducting research in the Appalachian mountain region of Ohio, an area where the cervical cancer death rate for white women is one of the highest in the country. We’ve launched two intervention studies to try to reduce risk factors. One is a smoking cessation study, because we know that smoking is related to cervical cancer. The second is a study exploring how we can motivate women who need a Pap test to get one.
Both studies use lay health advisers—women from the community who are trained to talk about these issues. The lay health advisers meet one-on-one with each woman, which allows them to address a woman’s specific barriers to care. A woman might not be getting Pap tests because she didn’t know she needed them, or it could be that her doctor didn’t recommend them. She might not trust her doctor, or have a ride to appointments, or have someone to watch her kids. Or, it could be that her husband doesn’t want her to be tested. Our focus groups showed that most people in Appalachian Ohio don’t understand the connection between the human papillomavirus (HPV) and cervical cancer. Instead, they think that cervical cancer is due to promiscuity. The lay health advisers are able to address misconceptions like this, which can also help increase Pap screening and, in turn, reduce cervical cancer deaths.