Increasing Racial Diversity in Cancer Research and Cancer Care Donita C

Published OnlineFirst August 18, 2020; DOI: 10.1158/2159-8290.CD-20-1193 VIEWS SCIENCE IN SOCIETY The Race toward Equity: Increasing Racial Diversity in Cancer Research and Cancer Care Donita C. Brady 1 , 2 and Ashani T. Weeraratna 3 , 4 Summary: Cancer research and cancer care require deliberate attention to racial diversity. Here we comment on the ongoing issues of diversity and racism in cancer research. INTRODUCTION Transformative, intentional initiatives at our institutions and funding agencies aimed at the retention and recruitment The horrifi c murders of George Floyd, Breonna Taylor, of Black trainees and professors within the cancer research and countless others have had a profound effect on the col- enterprise are therefore critical to creating preeminent aca- lective conscience of our society, prompting us to reexamine demic research environments ( 1 ). Furthermore, many cancers our own bias and survey for race-based discrimination to such as breast, lung, and prostate cancers disproportionately begin to acknowledge and combat the existing racism within affect people of color, and those health disparities need to our own ivory towers. This introspection has opened the be addressed. To do this, community outreach is critical to eyes of many to the overt and implicit biases Black scien- increase screening and encourage participation in clinical tists face. Essential discussions stemming from this new trials and laboratory-based studies. However, that cannot be awakening have been uncomfortable and eye-opening, and done without building trust between underrepresented com- have resulted in many important conversations on social munities and the medical institutions that have historically media and in person on our campuses. Although people betrayed them. Here, we attempt to succinctly identify these of color face similar micro- and macroaggressions, most challenges for cancer research and care, consider solutions have not been harassed as they came to and from campus to begin effecting actual change in academia, and provide like our Black colleagues, especially many of the men, or antiracism resources. Cancer research and cancer care require feared navigating their own neighborhoods or sleeping in deliberate attention to racial diversity. their own homes. Respected leaders in our cancer research fi eld such as Robert Winn, Cancer Center Director at Vir- ginia Commonwealth University, or Otis Brawley, former CHALLENGES, PROBLEMS, AND ISSUES Chief Medical and Scientifi c Offi cer and Executive Vice WITHIN THE BLACK CANCER RESEARCH President for the American Cancer Society and currently a Bloomberg Distinguished Professor and Associate Direc- COMMUNITY tor for Community Outreach at the Johns Hopkins Kim- The fi rst and overriding problem, not just in cancer research mel Comprehensive Cancer Center, have recently described but in all biomedical research, is the vast underrepresentation being held at gunpoint while walking to their cars, or in of minorities. The NIH defi nes underrepresented minorities front of their own homes ( https://cancerletter.com/articles/ (URM) very specifi cally as “US citizens or lawful permanent 20200605_1/ ). This ever-present reality permeates the minds residents who are African American/Black, Hispanic/Latinx, and informs the actions of our Black colleagues, and, as a American Indian, and Alaskan Native.” Although many insti- result, sets them on a different footing from the start no tutions have focused on increasing the input into the pipe- matter their socioeconomic status or level of education. line, beginning with efforts as early as middle school, the real problem comes at that transition from training to career. Gibbs and colleagues ( 2, 3 ) have shown that the number of URM receiving PhDs between 1980 and 2013 increased 1 Department of Cancer Biology, Perelman School of Medicine, University by a factor of 9.3, as compared with a 2.6-factor increase in of Pennsylvania, Philadelphia, Pennsylvania. 2 Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Penn- non-URM groups. Despite this, there was no similar increase sylvania, Philadelphia, Pennsylvania. 3 Department of Biochemistry and in the number of URM faculty recruited into assistant pro- Molecular Biology, The Johns Hopkins Bloomberg School of Public Health, fessor positions, whereas non-URM scientists transitioned 4 Baltimore, Maryland. The Johns Hopkins Kimmel Cancer Center, Balti- into faculty positions at rates refl ective of their entry into more, Maryland. academia. Using a model that took all of these factors into Corresponding Authors: Ashani T. Weeraratna, Johns Hopkins Bloomberg account, the authors came to the depressing conclusion that School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205. Phone: 410-955-3655; E-mail: [email protected] ; and Donita C. Brady, Perel- with no intervention, and even in the face of exponential man School of Medicine, University of Pennsylvania, 612 BRBII/III, Phila- growth in the URM student population, faculty diversity delphia, PA 19106. E-mail: [email protected] would remain static well into the next 50 years. These models Cancer Discov 2020;10:1451–4 highlight the problem with focusing large amounts of effort doi: 10.1158/2159-8290.CD-20-1193 on increasing the pipeline without similar efforts to increase ©2020 American Association for Cancer Research. retention. Diversity, equity, and inclusion (DEI) efforts have OCTOber 2020 CANCER DISCOVERY | 1451 Downloaded from cancerdiscovery.aacrjournals.org on September 27, 2021. © 2020 American Association for Cancer Research. Published OnlineFirst August 18, 2020; DOI: 10.1158/2159-8290.CD-20-1193 VIEWS Table 1. Antiracism resources Resource Links Websites consolidating incredible resources organized https://www.projecthome.org/anti-racism-resources by subject, from self-care, to discussing racism with https://diversity.unc.edu/yourvoicematters/anti-racism-resources/ children, to active antiracism guides https://www.forbes.com/sites/juliawuench/2020/06/02/fi rst-listen-then- learn-anti-racism-resources-for-white-people/ https://drive.google.com/fi le/d/1AoFbaCEfP5qgBMjKnpsnzx5idYPdbq6x/view Antiracist movies and TV shows https://www.glamour.com/story/anti-racist-movies-tv-shows-streaming https://www.harpersbazaar.com/culture/fi lm-tv/g32961462/black-history- movies-anti-racism/ https://time.com/5847912/movies-to-watch-about-racism-protests/ Podcasts https://www.wbur.org/artery/2020/06/05/podcasts-to-listen-to-about-race- america https://www.glamour.com/story/anti-racist-podcasts-and-talks https://bellocollective.com/16-podcasts-that-confront-racism-in-america- f8f69baf529d long been focused on students, and not only are URM “Target of Opportunity” programs should be made avail- faculty not included as targets of these efforts, they are asked able. Faculty searches should include a committee member to lead them, resulting in an increased workload that often dedicated to increasing URM applications through outreach goes uncompensated. Finally, URM faculty are also sub- and solicitation. Universities should keep on hand a list of jected to a lot of bias, both conscious and unconscious. As their talented minority alumni, tracking them through their with all academics who are URM, be they Black, Indigenous, graduate training and helping to promote them as faculty or immigrant, there are multiple micro- and macroaggres- candidates. All of these are easy initiatives that can help to sions that plague us. For an eye-opening list of these, search increase URM faculty hires. From there, efforts to increase under the hashtag #BlackInTheIvory or explore the Twitter the retention of these candidates need to be made. Above all account of the same name. This “death by a thousand cuts” these is the training of non-URM faculty in what implicit or is a recipe for ensuring an absence of URM populations in unconscious bias is and how to recognize and mitigate it in academia. dealings with fellow faculty and with trainees. As with every- thing, however, it is critical to note that although training What Can Be Done to Increase Diversity and discussion work, the effects are not self-sustaining, and in Academia? institutions will need to commit to gauging the effectiveness First and foremost, it is critical to maintain investment of the implicit bias training with clear metrics, continued into the pipeline. Bringing URM students into the pipeline implicit bias training as the research evolves, and systems for early and fi nding ways to effectively retain them through accountability, among other initiatives. Diversity initiatives their medical or scientifi c training is critical to creating should be rewarded rather than viewed as distractions, and and increasing the pool of candidates from which to draw leadership in cancer centers can do this by including DEI at later stages. Beyond the increases in the pipeline, more efforts as “credits” toward promotion and remunerating effective partnerships between minority-serving institutions them where appropriate. Requiring statements of commit- and cancer centers could provide increased opportunities for ment to these activities at different stages of promotion recruitment and knowledge exchange. Programs should be is also one way to increase the incentive to partake in DEI established for our URM students that address transition- efforts. The goal is to include non-URM faculty in these ing to graduate school (in the form of “boot camps” prior initiatives as well,

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