AACR CANCER DISPARITIES PROGRESS REPORT 2020 Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations AACR.org CancerDisparitiesProgressReport.org #CancerDisparitiesReport AACR CANCER DISPARITIES PROGRESS REPORT 2020 Achieving the Bold Vision of Health Equity for Racial and Ethnic Minorities and Other Underserved Populations PLEASE CITE THIS REPORT AS: CancerDisparitiesProgressReport.org [Internet]. Philadelphia: American Association for Cancer Research; ©2020 [cited year month date] Available from http://www.CancerDisparitiesProgressReport.org/. AACR.org CancerDisparitiesProgressReport.org #CancerDisparitiesReport ISBN: 978-1-7347432-0-3 Table of Contents A Message from the AACR .......................... 1 Understanding Cancer Development in the Context of Cancer Health Disparities ...34 Executive Summary .....................................2 Cancer Initiation: DNA at the Core of Cancer .......35 The State of Cancer Genetic Changes: DNA Mutations in Cancer ..........35 Health Disparities in 2020 ...........................8 Epigenetic Changes: DNA’s Third Dimension ......38 Disparities in the Burden of Cancer among Cancer Progression: Role of the U.S. Racial and Ethnic Population Groups ............. 11 Tumor Microenvironment ....................................... 40 Cancers with a Disproportionate Cancer and the Immune System ..............................41 Burden in African Americans......................................11 Cancer Metastasis .........................................................41 Cancers with a Disproportionate Burden in Hispanics ......................................................15 Integrating Our Knowledge: Cancers with a Disproportionate Charting the Path Forward .......................................41 Burden in Asians/Pacific Islanders .......................... 17 Cancers with a Disproportionate Burden Disparities in the Burden of in American Indians/Alaska Natives ........................18 Preventable Cancer Risk Factors ............. 43 Why Do Cancer Health Disparities Exist?..............20 Tobacco Use ...............................................................45 Social Factors Contributing Obesity ........................................................................48 to Cancer Health Disparities .....................................20 Dietary Factors ..........................................................50 Clinical Factors Contributing Physical Activity ........................................................53 to Cancer Health Disparities ......................................21 UV Exposure...............................................................54 Behavioral and Cultural Factors Infectious Agents ......................................................55 Contributing to Cancer Health Disparities ............ 22 Social and Behavioral Stressors ..............................57 Psychological Factors Contributing to Cancer Health Disparities ..................................... 22 Other Cancer-causing Factors ................................57 Environmental Factors Contributing Outdoor Air Pollution ..................................................58 to Cancer Health Disparities .....................................23 Pesticides and Endocrine-disrupting Biological and Genetic Factors Chemicals ........................................................................58 Contributing to Cancer Health Disparities ............23 Night Shift Work ...........................................................58 Health Disparities: A Costly Public Health Challenge; Health Equity: A Vital Investment ......25 Disparities in Cancer Screening for Early Detection .................................... 59 Special Feature on Disparities in How Can We Screen for Cancer and What COVID-19 and Cancer ................................27 Are the Screening Recommendations? .................59 Why Do COVID-19 Disparities Exist? ......................27 Cancer Screening among U.S. Racial and Ethnic Groups ........................................ 60 Disparities in SARS-CoV-2 Testing .........................30 Breast Cancer Screening ...........................................62 COVID-19 and Cancer Health Disparities ................31 Cervical Cancer Screening ........................................64 COVID-19 Disparities: A Window of Opportunity to Achieve the Bold Vision of Health Equity? .......32 Colorectal Cancer Screening ....................................65 Special Feature References .....................................33 Lung Cancer Screening ...............................................71 ii | AACR Cancer Disparities Progress Report 2020 Prostate Cancer Screening .........................................71 Cancer Workforce Landscape ................................. 110 Increasing Cancer Screening Rates Research Scientists .....................................................110 among Racial and Ethnic Minorities ........................71 Physicians ....................................................................111 Other Health Care Professionals ...........................111 Disparities in Cancer Treatment................73 Achieving Health Equity through a Disparities in Treatment with Surgery ...................75 Strong and Diverse Future Workforce .................. 112 Disparities in Treatment with Radiotherapy .........76 Disparities in Therapeutic Overcoming Cancer Cancer Clinical Trials ................................................ 80 Health Disparities through Lack of Diversity among Science-based Public Policy ....................114 Clinical Trial Participants ............................................80 Funding for Research and Programs How Can We Overcome the Current That Address Disparities and Barriers to Trial Participation? ..................................82 Promote Health Equity ............................................ 115 Disparities in Treatment with Collaborative Resources to Advance Systemic Therapeutics .............................................83 Research for Health Equity .....................................116 Achieving Equity in Quality Cancer Care ..............89 Public Health Policies to Regulate and Reduce the Use of Tobacco Products ................... 117 Disparities in Cancer Survivorship ........... 93 Achieving the Elimination of Cervical Cancer in the U.S. by Addressing Disparities .......118 Disparities in Long-term and Late Effects of Cancer Treatment ....................................94 Policies to Address Obesity, Poor Diet, and Physical Inactivity ......................... 119 Disparities in Health-related Quality of Life .........95 Policies to Address Disparities Disparities in Financial Toxicity ..............................96 in Cancer Screening ................................................. 119 Paving the Way for Health Equity for Racial Diversifying Representation in Clinical and Ethnic Minority Cancer Survivors ...................96 Trials by Addressing Barriers in Trial Design ...... 122 Imprecision of Precision Medicine ......... 100 Diversifying Representation in Clinical Trials by Addressing Barriers for Patients ........... 123 Precision Medicine: The Promise ..........................100 Improving Access to High-Quality Precision Medicine: The Challenges ......................101 Clinical Care ............................................................. 124 Precision Medicine: The Future Provides Coordination of Health Disparities Opportunities to Achieve Health Equity ............. 102 Research and Programs within the Federal Government ........................................ 124 Overcoming Cancer Health Disparities through Diversity in The AACR Call to Action .......................... 125 Cancer Training and Workforce ..............105 References ................................................ 127 Diversity in Cancer Training ..................................106 Cancer Training Landscape ..................................... 107 Glossary ....................................................140 Diversity in the Cancer Workforce .......................108 Index .........................................................144 American Association for Cancer Research® | iii AACR CANCER DISPARITIES PROGRESS REPORT 2020 Steering Committee JOHN D. CARPTEN, PhD (Chair) RICK A. KITTLES, PhD Professor, Department of Urology; Chair, Professor and Founding Director, Department of Translational Genomics; Division of Health Equities Director, Institute for Translational Genomics; City of Hope Comprehensive Cancer Center Director, Molecular Genomics Core; Co-Leader, Duarte, California Norris Comprehensive Cancer Center University of Southern California WILLIAM G. NELSON, MD, PhD Los Angeles, California Professor and Director, Sidney Kimmel Comprehensive Cancer Center ELAINE R. MARDIS, PhD, FAACR Johns Hopkins University The Steve and Cindy Rasmussen Nationwide Baltimore, Maryland Foundation Endowed Chair in Genomic Medicine; Co-Executive Director, The Steve and Cindy LISA A. NEWMAN, MD, MPH Rasmussen Institute for Genomic Medicine Chief, Section of Breast Surgery; Chief, Breast Nationwide Children’s Hospital Cancer Disease Management Team; Chief of the Professor of Pediatrics Breast Surgical Oncology Programs of the The Ohio State University College of Medicine NYP-WCM Network Columbus, Ohio Weill Cornell Medicine New York, New York JOHN M. CARETHERS, MD, MACP C. Richard Boland Distinguished University BRIAN M. RIVERS, PhD, MPH Professor; John G. Searle