A presentation on cancer and ethnicity in the United States, and how the US can learn from other countries in regards to cancer control. - by Barri Blauvelt, CEO, Innovara, Inc.

1. U.S. Ethnicity and Cancer:
Learning From the World
Barri M. Blauvelt
CEO, Innovara, Inc.
www.innovara.com
October 16, 2013

2. In 2009, President Barack Obama called for a new,
In 2009, President Barack Obama called for a new,
integrated global health strategy and for “…a new effort
integrated global health strategy and for “…a new effort
to conquer a disease that has touched the life of nearly
to conquer a disease that has touched the life of nearly
every American, including me, by seeking a cure for
every American, including me, by seeking a cure for
cancer in our time.”11
cancer in our time.”
1) Dunham, Will. “Obama cancer cure vow requires more funds: experts.” Reuters. Feb. 25, 2009. Available at:
http://www.reuters.com/article/healthNews/idUSTRE51O7JC20090225
Picture: http://www.ncrr.nih.gov/strategic_plan/online_version/images/people-map.jpg

3. This presentation:
 Demographics of cancer and global impact
 Cancer in different ethnic groups
 Ethnic challenges in research
 Influence of Health Insurance and SES
 Prevention and Obesity
 A Potential Model for National Cancer Control

4. Cancer - a Growing Problem
 Cancer 2nd leading cause of death in world2; soon to be
No. 1
 In past 30 years, the burden of cancer has doubled2
 30% growth in new cancer cases by 20203
 2/3 of new cases from lower- and middle-income
countries.2, 3
 Estimates suggest global economic impact exceeds US
$300 Billion 3
2) Boyle and Levin (eds.). World Cancer Report 2008, Lyon: International Agency for Research on Cancer, 2008.
3) New cancer cases will grow 30% by 2020; current year estimates suggest global economic impact exceeds US $300bn. Economist Intelligence Unit,
2009. Downloadable at www.eiu.com_info.com

5. Inequitable Allocation Of Cancer Resources
 Only 5% of resources invested in developing world.3
 Less than 15% of clinical research spending in developing world4
 3 major sources account for 2/3 of research funding5 :
 US Government - 34%
 Top 24 pharmaceutical companies - 22%
 EU health care and university systems - 10%
“The irony and the tragedy is that around the world
“The irony and the tragedy is that around the world
the policy community in conjunction with medical
the policy community in conjunction with medical
providers already can do much to control this
providers already can do much to control this
devastating disease.”66
devastating disease.”
4) Clinicaltrials.gov (www.clinicaltrials.gov), Sep. 28, 2009
5) ECRM survey (www.ecrmforum.org) cited in “Responding to the challenge of cancer in Europe”. Original survey data represent research funding in 2003. Funding
estimates were inflated to 2009 US$ using the US Consumer Price Index.
6) Kort EJ, et al. The decline in U.S. cancer mortality in people born since 1925. Cancer Research 2009; 69(16): 6500-6505

6. Breast Cancer Exemplifies Inequitable
Allocation
 In USA and EU effectively being controlled in up to 80% of some
populations of women
 However, breast cancer is leading cause of cancer death in most nonwhite women around the world (including US) 6
 Why this disparity between white non-Hispanic women and non-white
women in breast cancer deaths?
 Reasons explored in a joint study of University of Massachusetts and
Johns Hopkins in an international horizon scanning study in breast
cancer, from 2006 to 20087
7) Buchanan D, Blauvelt B, et al. Breast cancer and ethnicity – A survey of thought leaders in Latin America, Asia and the Middle East. The Breast Conference, Sept.
2008.

7. UMass/Johns Hopkins Horizon Scanning Study
 Encompassed 30 countries across 3 regions of the world: Asia, Latin
America and Middle East/Africa
 Accounts for approximately 60% of world population
 90% of collective population is non-White
Key Finding: As in US, non-Caucasian ethnicities
Key Finding: As in US, non-Caucasian ethnicities
present with breast cancer at a significantly
present with breast cancer at a significantly
younger age and with more aggressive tumors
younger age and with more aggressive tumors
than their white counterparts
than their white counterparts

8. UMass/Johns Hopkins Horizon Scanning Study7
 Part of this difference for ethnically diverse groups is attributed to
differences in:
 Lifestyle and cultural attitudes
 Lack of prevention and early detection
 Lack of education and advocacy
 Issues related to access to care
 Affordability
 Environmental factors
 Genetics
 Most of the countries involved in the study noted they lacked the
resources and know-how to conduct adequate research. 8,9
8) El Saghir NS, Khalil MK, et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis.
International Journal of Surgery, (2007) 5, 225-233.
9) Anderson BO et. al. “Guidelines for International Breast Health and Cancer Control-Implementation" Cancer, October 15, 2008 Supplement

9. Cancer Guidelines and Policies Need to Adapt
“The [NCCN] Guidelines, which these countries try to follow, simply do not
“The [NCCN] Guidelines, which these countries try to follow, simply do not
work for ethnically diverse and economically challenged populations.”
work for ethnically diverse and economically challenged populations.”
NCCN and other cancer guidelines mainly are based upon research done in
white populations and may not be appropriate
If treatment guidelines don’t work in ethnically diverse and economically
challenged populations outside of the USA, they also are unlikely to work in
similarly challenged populations within the USA
A significant need and opportunity exists for greater diversity in cancer,
epidemiology, socioeconomics and related research in order to formulate
success strategies and policies to control cancer in America’s increasingly
culturally and ethnically diverse populations

10. Cancer in Different Ethnicities in USA:
Hispanics
Compared to non-Hispanic Caucasian populations:
Both Hispanic men and women are twice as
likely to have and die from liver cancer
Hispanic women are 2.7 times more likely to
have stomach cancer
Hispanic women are twice as likely to have
cervical cancer, and 1.5 times more likely to die
from cervical cancer
10) Office of Minority Health, US Department of Health and Human Services, Cancer and Hispanic Americans,
http://www.omhrc.gov/templates/content.aspx?lvl=2&lvlID=54&ID=3323

11. Cancer in Different Ethnicities in US:
Asians/Pacific Islanders
Compared to non-Hispanic Caucasian populations:
 Asian/Pacific Islander men are twice as likely to
die from stomach cancer
 Asian/Pacific Islander women are 2.6 times as
likely to die from the same disease
 Both Asian/Pacific Islander men and women
have three times the incidence of liver &
Intrahepatic Bile Duct cancer
11) Office of Minority Health, US Department of Health and Human Services, Cancer and Asian/Pacific Islanders,
http://www.omhrc.gov/templates/content.aspx?lvl=2&lvlID=53&ID=3055

12. Cancer in Different Ethnicities in US:
African Americans
African Americans have the highest mortality rate of
any racial and ethnic group for all cancers combined
and for most major cancers
Compared to non-Hispanic Caucasian populations:
African American men are twice as likely to have
new cases of stomach cancer
African American women are 10% less likely to
have been diagnosed with breast cancer,
however, they were 34% more likely to die from
breast cancer
12) Office of Minority Health, US Department of Health and Human Services, Cancer and African Americans,
http://www.omhrc.gov/templates/content.aspx?lvl=2&lvlID=51&ID=2826

13. Differences in Breast Cancer by Race & Ethnicity

In US, mean age of breast cancer diagnosis:
•
American Indian - 54 ±13
•
Hispanic - 56 ±14
•
Asian/Pacific Islanders - 57±13
•
Blacks - 57± 17
•
Whites [Caucasians] - 62 ±14

Blacks, American Indians, and Hispanics:
•
had 1.7 to 2.5 fold increase risk of stage III and stage IV breast tumors
•
had 1.3 to 2 fold greater risk of breast cancer related mortality

In stage I or II breast cancer patients with tumors smaller than 5.0 cm, Blacks, other
Asians and Pacific Islanders, Mexicans, and Puerto Ricans were 20% to 50% more
likely to receive inappropriate primary surgical and radiation breast cancer
treatment
13) Christopher Li, et al: Differences in Breast Cancer Stage, Treatment, and Survival by Race and Ethnicity, Arch Intern Med. 2003;163:49-56

14. Ethnic Challenges in Cancer Research and Care
 Some examples of mistrust, fear, social and other cultural beliefs:
• Some fear genetic research in case they may be considered
unmarriageable8
• If people knew they had “cancer genes” they will consider cancer
“inevitable” and therefore not try to adopt healthier lifestyles 14
• Chinese may be reluctant to try to be part of any research for fear of
learning they have and being rejected due to HBV/HCC 15
• In Africa, people are reluctant to participate in cancer research because
they fear learning that they have HIV and other diseases. 16
• In some countries, women chose to have breast cancer or delay seeking
treatment, for fear of losing their hair or surgical disfigurement 7
14) Lara, A (Deputy Minister of Health, Federal Government of Mexico), “The Delta Project”, July, 2005.
15) Cheng AL, et al. “Epidemiological Perspective: HBV Vaccinations and Implications in HCC Development.” International Liver Cancer Association, Sept. 2009.
16) Kerr D et al, London Declaration on cancer control in Africa (presentation and discussions during the Cancer Control in Africa Meeting, May 10 – 11, 2007, London, UK.

15. Some Further Examples of Disparities
 Studies on communications with patients
• Oncologists appear to communicate differently with breast cancer patients, depending
on the women's race, age, and other factors 17
• Poor communication of mammogram results may explain disparities in breast cancer
diagnosis and outcomes18
 Studies on screening and treatment
• Poor, minority, and uninsured individuals have reduced access to screening and surgery
for colorectal cancer19
• Perceived racial discrimination in adherence to screening mammography guideline 20
• Minority women are less likely to receive adjuvant therapies following breast cancer
surgery21
• Disparities in receipt of chemotherapy following ovarian cancer surgery 22
• Socioeconomic barriers exist to timely diagnosis and treatment of prostate cancer in
black men23
17) Siminoff, Graham, and Gordon, Patient Educ Counsel 62:355-360, 2006 (AHRQ grant HS08516). See also Carter, Zapka, O'Neill, et al., Palliat Support Care 4:257-271, 2006 (AHRQ grant HS10871).
18) Jones, Reams, Calvocoressi, et al., Am J Public Health 97(3):531-538, 2007 (AHRQ grant HS11603) and Dailey, Kasl, Holford, and Jones, Am J Epidemiol 165(11):1287-1295, 2007 (AHRQ grant HS15686).
19) Phillips, Liang, Ladabaum, et al., Medical Care 45(2):160-167, 2007 (AHRQ grants HS10771 and 10856); Diggs, Xu, Diaz, et al., Am J Manag Care 13(3):157-174, 2007 (AHRQ grant T32 HS00059); Zhang, Ayanian,
and Zaslavsky, J Qual Health Care 19(1):11-20, 2007 (AHRQ grant HS09869). See also Guerra, Dominguez, and Shea, J Health Commun 10:651-663, 2005 (AHRQ grant HS10299).
20) Dailey, Kasl, Holford, and Jones, Am J Epidemiol 165:1287-1295, 2007 (AHRQ grant HS15686). See also Jones, Reams, Calvocoressi, et al., Am J Public Health 97(3):531-538, 2007 (AHRQ grant HS11603);
Rauscher, Hawley, and Earp, Prev Med 40:822-830, 2005 (AHRQ grant T32 HS00007).
21) Bickell, LePar, Want, and Leventhal, J Clin Oncol 25(18):2516-2521, 2007. See also Bickell, Wang, Oluwole, et al., J Clin Oncol 24(9):1357-1362 (AHRQ grant HS10859).
22) Du et al, Studies finds disparities in receipt of chemotherapy following ovarian cancer surgery. Int J Gynecol Cancer 18(4):660-669, 2008
23) Talcott et al. Socioeconomic barriers exist to timely diagnosis and treatment of prostate cancer in black men. Cancer 109(8): 1599-1606, 2007

16. Clinical Trials Lack Ethnically Diverse
Representation
 Clinical Trials
• Fewer than 10% of U.S. clinical trial participants come from AfricanAmerican, Latino, and Asian populations 24
Source: Baseline Study of Patient Accrual Onto Publically Sponsored Trials, “Coalition of Cancer
Groups of the Global Access Project, National Patient Advocate Foundation, April 2006.
24) Evelyn B, Toigo T, Banks D, et al. Participation of racial/ethnic groups in clinical trials and race related labeling: a review of new molecular
entities approved 19951999. J Natl Med Assoc. 2001;93:18S-24S.

17. Barriers to Clinical Trials Result in
Underrepresentation of Non-Caucasians
Participant Barriers to Participation:
• Mistrust
• Lack of awareness
• Cultural barriers
• Language/Linguistic differences
• Socioeconomic obstacles
• Cost/Lack of insurance
• Study design eligibility criteria
25) The EDICT Project: Policy Recommendations to Eliminate Disparities in Clinical Trials: EDICT: Eliminating Disparities in Clinical Trails (10/2008, Version 2 )

18. Barriers to Clinical Trials Result in
Underrepresentation of non-Caucasians
Physician/Investigator Barriers to Referring Participants
to Clinical Trials:
•Lack of non-Caucasian investigators
•Lack of physician referral
•Lack of physician awareness
•Participants are also often excluded from clinical trials
due to characteristics, preferences, and circumstances
of the physicians who conduct or refer patients to
clinical trials
25) The EDICT Project: Policy Recommendations to Eliminate Disparities in Clinical Trials: EDICT: Eliminating Disparities in Clinical Trails (10/2008, Version 2 )

19. Opportunities to Increase Diverse Ethnicity
Participation in Clinical Trials
 Physician’s ethnicity is an important factor in influencing patient
participation in a clinical trial
• Black and Latino (and some Asian) physicians are more likely to treat
patients of a similar race and ethnicity 26
 Issue of underrepresentation of African Americans in research implies that
more minority physicians should be recruited into clinical research [and
into cancer specialties]. 26
 Over 85% of communications on participation in clinical trials by both US
government (NCI, NIH and others) and the major pharmaceutical
companies found to be only available in English. 27
• Fewer than 10% were bi-lingual (and almost none multilingual)
26) Getz K, Peddicord D, Minorities underrepresented in clinical trials, Special to The Washington Post, October 2, 2008.
27) Innovara, Inc. How Difficult Is It to Enroll in Clinical Access Trials? Scheduled for publication in January, 2010.

20. Influence of Health Insurance and
Socioeconomic Status (SES)
 As of 2009, 1:4 non-Caucasian in the USA will forego the cancer treatment due to
costs (1:8 in overall population)
 In a breast cancer study, women who were uninsured or had Medicaid coverage
compared to those who had Medicare or private insurance were 65% less likely to
receive adjuvant treatment28
 Researchers compared black and white men diagnosed with prostate cancer from
the North Carolina Cancer Registry23
 Both had to travel similar distances for health care 23
 Black men still had less access to care23
 Also had poorer health insurance coverage and less continuity of care,
used more public clinics and emergency wards, and expressed less trust in
their physicians23
 Conclusion: Barriers to early diagnosis and appropriate care for prostate cancer
among black men were related more to SES than to lack of education or
cultural misunderstanding23
28) Gelber et al. Study finds racial disparities in receipt of breast-conserving therapy among women with early-stage breast cancer. Ann Surg Oncol 13 (7): 977-984, 2006

21. Influence of Health Insurance and
Socioeconomic Status (SES)
 In 2008, research in women with ovarian cancer showed those of higher
SES had increased use of surgery and chemotherapy; women in the lowest
quartile of SES were more likely to die than those in the highest quartile 22
 In colorectal cancer, a 2007 study demonstrated that poor, minority and
uninsured individuals have reduced access to screening and surgery for
colorectal cancer, independent of other patient characteristics. 23
 It is important to recognize that when policy for cancer control is
formulated for diverse ethnicities, in many cases this may present
additional challenges not only in terms of socioeconomic status, but also
access to health care insurance
 Percentage of uninsured Americans by race29:




White Americans - 11%
Asians – 18%
Blacks - 19%
Hispanics - 31%
29) Income, Poverty, and Health Insurance Coverage in the United States: 2008, US Census Bureau, US Department of Commerce

22. Cancer Control Must Start with Prevention
 The President’s Cancer Panel already has identified tobacco and obesity
reduction as important to cancer prevention, 30 as has the American Cancer
Society.31
 Obesity and physical inactivity may account for 25% to 30% of several
major cancers, including cancer of the gall bladder, ovaries and pancreas. 32
 Obese people may have a 19 % higher risk of pancreatic cancer than those
with a normal BMI 33
• Obesity may also correlate to the higher pancreatic cancer risk among
black Americans.34
30) President’s Cancer Panel, 2007.
31) Cancer Statistics 2009: A presentation from the American Cancer Society, American Cancer Society, 2009.
32) Vainio H, Bianchini F. IARC handbooks of cancer prevention. Volume 6: Weight control and physical activity. Lyon, France: IARC Press, 2002.
33) Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. British Journal of Cancer 2003; 89(3):519–523.
34) AOA Fact Sheets: Obesity in Minority Populations, American Obesity Association, May 2, 2005,
http://obesity1.tempdomainname.com/subs/fastfacts/Obesity_Minority_Pop.shtml

23. Obesity & Smoking Status
• Minorities especially Blacks, American Indians and /or Mexicans appear less
physically active 35
• In compare to other populations, Asians smoke the least 35
Race
Inactive
Regular Leisuretime Activity
Race
Smoking
Status
White
37.4
32.1
White
20.3
Black or African
51.0
23.0
Black or African
19.0
American Indian or Alaskan Native
39.8
22.6
American Indian or Alaskan
Native
27.7
Mexican or Mexican American
51.9
22.7
Mexican or Mexican American
12.7
Asian
38.9
30.1
Asian
9.2
2 or more races
2 or more races
Black or African American, white
42.0
29.9
Black or African American, white
15.4
35) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2007, US Department of Health and Human Services, Center for Disease Control and
Prevention, National Center for Health Statistics

24. Obesity in America
In comparison to other populations, the Asian population was
least overweight or obese 35
Race
% Over-weight
% Obese
Race
35.1
25.9
White
35.1
25.4
Black or African
35.1
35.1
American Indian or Alaskan Native
34.7
32.4
Mexican or Mexican American
40.3
29.9
Asian
29.2
8.9
2 or more races
35.0
31.2
Black or African American, white
44.4
20.2
35) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2007, US Department of Health and Human Services, Center for Disease Control and
Prevention, National Center for Health Statistics

25. Obesity in America
 African Americans were 1.4 times as likely to be obese as non-Hispanic
Caucasians
 Hispanic adults were 50% less likely to engage in active physical activity as nonHispanic Whites
 African American women have the highest rates of being overweight or obese
compared to other groups in the U.S.
•
About four out of five African American women are overweight or obese
 73 percent of Mexican American women are overweight or obese compared to
61.6 % of the general female population
 Minority women with low income appear to have the greatest likelihood of
being overweight

Among Mexican American women, age 20 to 74, the rate of overweight is about 13 percent
higher for women living below the poverty line versus above the poverty line
35) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2007, US Department of Health and Human Services, Center for Disease Control and
Prevention, National Center for Health Statistics

26. Obesity Increases the Risk of Cancer
 Obesity and physical inactivity may account for 25 to 30% of several
major cancers32
 In 2002, about 41,000 new cases of cancer in the US were estimated
due to obesity 36
 In the US, 14% of death from cancer in men and 20% deaths in women
may be due to overweight and obesity37
36) Polednak AP. Trends in incidence rates for obesity-associated cancers in the U.S. Cancer Detection and Prevention 2003; 27(6):415–421.
37) Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. New England Journal of
Medicine 2003; 348(17):1625–1638.

27. Immigrants Face Increasing Risk of Cancer31
Cancer Rates for Hispanics in Florida were at least 40% higher than Hispanics
in their countries of origin38
Among Cubans and Mexicans in Florida, the risk for colorectal cancer was more than double
the risk in Cuba and Mexico. The same was true for lung cancer among Mexican and Puerto Rican
women in Florida compared with women in their homelands38
"There is no reason to believe that the people who came to Florida from the Latin countries are
different from those who stayed," said Dr. Paulo S. Pinheiro, a researcher in the university's
department of epidemiology. "Since there is no genetic difference, if there is a difference it will
be in the lifestyles they adopt once they come to the United States." 38
Cancer expert Vilma Cokkinides agrees that unhealthy lifestyle changes increase the cancer risk
for Hispanic immigrants. "Immigrants who come and stay longer in the United States start
adopting lifestyles that can lead to greater cancer incidents," said Cokkinides, strategic director of
risk factor surveillance at the American Cancer Society. "Smoking, diet, lack of physical activity
and exposure to certain chemicals tend to lead to a higher risk of cancer.“38
31) Cancer Statistics 2009: A presentation from the American Cancer Society, American Cancer Society, 2009.
38) Pinheiro PS et al. Cancer Incidence in first generation US Hispanics. C Epid Biom Prev 2009; 18(8). August 2009

28. A Potential Model for Cancer Control
The taxonomy modeled by JHU based upon analysis of data from UMass/Johns Hopkins study may help
The taxonomy modeled by JHU based upon analysis of data from UMass/Johns Hopkins study may help
to serve as aapotential model against which to assess additional strategies for better control cancer in
to serve as potential model against which to assess additional strategies for better control cancer in
the USA, embracing and to the benefit all diverse cultures and ethnicities.38
the USA, embracing and to the benefit all diverse cultures and ethnicities.38
Building Capacity
Building Capacity
Promoting Advocacy
Promoting Advocacy
Comprehensiv
e
Framework for
National
Cancer Control
Strategies
Developing Evidence
Developing Evidence
Removing Barriers
Removing Barriers
39) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis,
28

29. 1) Removing Barriers
Barriers:
Out-of-pocket
costs
Disparities in
access
High cost to payers
Early detection
Reimbursement
Provide access to early detection and screening via public and
Provide access to early detection and screening via public and
private means.
private means.
••France: All cancer screening is free to all citizens and
France: All cancer screening is free to all citizens and
public health care workers are measured on their
public health care workers are measured on their
achievement of assigned populations to be screened
achievement of assigned populations to be screened
••Taiwan:Breast care and early detection taught in public
Taiwan: Breast care and early detection taught in public
school
school
Ensure that health insurance and providers ensure all patients
Ensure that health insurance and providers ensure all patients
have access to cancer diagnosis, therapy and care as
have access to cancer diagnosis, therapy and care as
established by national guidelines.
established by national guidelines.
••Singapore: Highly rated and cost effective health care
Singapore: Highly rated and cost effective health care
system where health insurance is an elegantly simple
system where health insurance is an elegantly simple
and cost-effective system
and cost-effective system
39) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis, submitted to The Breast Journal

30. 2) Building Capacity
Capacity
Science and
research
Skilled nurses
Research
infrastructure
National
statistics
Public
education
Australia
Australia
••Emphasis is placed on ensuring adequate numbers of oncology nurses
Emphasis is placed on ensuring adequate numbers of oncology nurses
highly skilled in patient and family education, counseling and research.
highly skilled in patient and family education, counseling and research.
•• Organizations such as the renowned Australia New Zealand Breast
Organizations such as the renowned Australia New Zealand Breast
Cancer Trials Group ensure that every research protocol is scrutinized
Cancer Trials Group ensure that every research protocol is scrutinized
by highly skilled consumers, most of whom are cancer survivors
by highly skilled consumers, most of whom are cancer survivors
themselves.
themselves.
Japan
Japan
•• The government accepts shared responsibility for licensing of
The government accepts shared responsibility for licensing of
physicians and other health care professionals and approvals of
physicians and other health care professionals and approvals of
medicines, devices and diagnostics.
medicines, devices and diagnostics.
••It therefore also limits liability, which further helps keeps liability (and
It therefore also limits liability, which further helps keeps liability (and
awards for malpractice or harmful results of medical care), health
awards for malpractice or harmful results of medical care), health
insurance and related legal costs well under control.
insurance and related legal costs well under control.
39) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis, submitted to The Breast Journal

31. 3) Developing Evidence
Dimensions
Study of local
etiology
Personalized
therapy
Developing
guidelines
International
networks
Local
communication
More funding of basic, ethnically related research alone or in
More funding of basic, ethnically related research alone or in
collaboration with other countries with similar ethnic
collaboration with other countries with similar ethnic
populations create knowledge synergies (and research done
populations create knowledge synergies (and research done
outside of US may also be significantly more cost-effective).
outside of US may also be significantly more cost-effective).
Examples such as the GSK Ethnic Research Initiative, or Susan G
Examples such as the GSK Ethnic Research Initiative, or Susan G
Komen’s and Gates’ Foundations and many other
Komen’s and Gates’ Foundations and many other
collaborations in research with industry, government and
collaborations in research with industry, government and
advocacy are to be commended.
advocacy are to be commended.
The US has outstanding pathology and other diagnostic/
The US has outstanding pathology and other diagnostic/
laboratory capabilities and biomarker technologies and the
laboratory capabilities and biomarker technologies and the
ability to develop and maintain quality tissue banks for shared
ability to develop and maintain quality tissue banks for shared
research, which may serve not only its own diverse
research, which may serve not only its own diverse
populations, but the world. In turn, this will help to create new
populations, but the world. In turn, this will help to create new
jobs, mainly in the US.
jobs, mainly in the US.
39) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis, submitted to The Breast Journal

32. 4) Promoting Advocacy
Advocacy
Patient
empowerment
Managing
survivorship
Quality of life
Metastic
disease
Organized
advocacy
Encourage and support ethnically and culturally diverse cancer
Encourage and support ethnically and culturally diverse cancer
advocacy initiatives and collaborations. Advocacy also means that the
advocacy initiatives and collaborations. Advocacy also means that the
patients are empowered to ensure quality care balanced/quality of life.
patients are empowered to ensure quality care balanced/quality of life.
Taiwan: National coalitions form that allow local, special interest and
Taiwan: National coalitions form that allow local, special interest and
other smaller, diverse advocacy groups obtain aabigger voice at the
other smaller, diverse advocacy groups obtain bigger voice at the
national level.
national level.
Quebec: Cancer specialists organized themselves and taught primary
Quebec: Cancer specialists organized themselves and taught primary
care physicians resulting in as good as, ififnot better, ongoing cancer
care physicians resulting in as good as, not better, ongoing cancer
care.
care.
In the US, the Fred Hutchinson Cancer Institute has translated
In the US, the Fred Hutchinson Cancer Institute has translated
guidelines for the Breast Health Global Initiative in many different
guidelines for the Breast Health Global Initiative in many different
languages of the world.
languages of the world.
Cancer advocacy groups should evaluate how they may better serve
Cancer advocacy groups should evaluate how they may better serve
culturally and ethnically diverse patient groups.
culturally and ethnically diverse patient groups.
39) Bridges J, Anderson, BO et al (2009) A Comprehensive Framework for National Breast Cancer Control Strategies: A Horizon Scanning Analysis, submitted to The Breast Journal

33. THE GOOD NEWS…
• Need for new policies and practices to be developed
to better control cancer in America’s increasingly
culturally and ethnically diverse nation
• America does not have to learn on its own
• It has much to learn from the rest of the world as the
world may learn from it
• As a result, when the US succeeds in achieving better
control of cancer across its rich and diverse
population; everyone - not only in the US, but in the
world - will benefit.

34. www.innovara.com