Health Equity and Access Weekly Roundup: December 9, 2023

Obesity Advocates Challenge FDA Over Drug Approval Process Disparities

Leading organizations in obesity and metabolic health fields, such as the American Society for Metabolic and Bariatric Surgery, jointly urged the FDA to address gaps in drug testing. The statement emphasized the absence of specific testing and exclusion of individuals with obesity in trials, leading to potentially unsafe dosing instructions. People with obesity, constituting 42% of the US population, face unnecessary risks. The organizations called for drug companies to update labels with accurate usage instructions and called on Congress and the FDA to mandate relevant testing. Prolonged drug interactions and underdosing were among the severe consequences noted, stressing the importance of ensuring safety and efficacy for this population.

SDOH in Cancer Care Highlight Multifactorial Equity Issues

The 46th annual San Antonio Breast Cancer Symposium featured discussions on the critical role of social determinants of health (SDOH) in the cancer care continuum. Experts addressed the impact of SDOH on community, social services, and individual health care needs. Amelie Ramirez, DrPH, MPH, emphasized the need for culturally sensitive frameworks to address disparities in communities, highlighting stark differences in San Antonio neighborhoods. Brenda A. Adjei, EdD, MPA, discussed NCI data on multilevel barriers to addressing social risks in cancer care, emphasizing the bidirectional relationship between social risks and health disparities. Brian M. Rivers, PhD, MPH, focused on clinical strategies to address SDOH, emphasizing the complex interplay of factors and the need for multifactorial interventions. The experts underscored the importance of identifying and addressing nonmedical barriers to health equity, incorporating social care into health care delivery, and supporting research initiatives to guide equitable cancer care.

Race/Ethnicity May Influence Local Recurrence in DCIS, Adjuvant Treatment

A retrospective analysis of women with ductal carcinoma in situ (DCIS) treated at Memorial Sloan Kettering Cancer Center revealed significant racial disparities in the 10-year local recurrence (LR) rates following breast-conserving surgery (BCS). Black women exhibited a higher 10-year LR rate compared with Asian, Hispanic, and White women, both overall and after receiving radiotherapy. The study included 4207 cases, with Black women having the highest cumulative incidence of LR (25%). Even after adjusting for various factors, Black women with DCIS had a 48% higher risk of LR after BCS compared with White women.

Research Reveals the Role of Structural Racism in Lung Cancer Risk

A scoping review investigated the impact of structural racism on the unequal distribution of lung cancer risk factors among racial and ethnic minority groups. The comprehensive analysis identified key domains, including housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. The review revealed that racial residential segregation and concentrated neighborhood deprivation led to increased exposure among minority groups to air pollution, radon, asbestos, and secondhand smoke. Occupational exposure to carcinogens was higher for racial and ethnic minority groups, particularly African Americans. Health care inequities, economic disparities, discriminatory industry practices, perceived stress, discrimination, and criminal justice involvement all contributed to disparate lung cancer risks.

New Insights on Breast Cancer Outcomes Among Sexual, Gender Minorities

Researchers at the San Antonio Breast Cancer Symposium addressed the lack of representation of sexual and gender minority individuals in cancer research. In one ongoing pilot study, investigators assessed the impact of gender-affirming chest masculinization surgery on breast cancer risk among transgender and gender-diverse individuals assigned female or intersex at birth. The study aimed to identify those at elevated lifetime breast cancer risk and determine if a true oncologic risk-reducing mastectomy is warranted. In another poster, researchers compared lifestyle risk factors and care access for breast cancer risk between cisgender women who identify as bisexual or lesbian (SMW) and heterosexual women. The study revealed that SMW face disparities in routine care access and higher-risk activities, highlighting the need for further research to address these health inequities.

California Aims for Equity by Redefining Cancer Care

The California Cancer Care Equity Act (CCCEA), implemented on March 1, 2023, is a significant step in addressing cancer care disparities for the state's 13.9 million Medi-Cal beneficiaries. A JAMA Oncology Viewpoint article highlighted key aspects of the CCCEA, such as its focus on improving access for Medicaid-insured patients by requiring managed care plans to contract with specialized cancer centers. The authors noted the importance of ongoing monitoring and data collection to ensure the CCCEA's effectiveness in reducing disparities in cancer outcomes and suggested potential improvements, including expanding the definition of complex cancers to include early-stage diagnoses and addressing barriers beyond access to specialists. The article emphasized the need for community partnerships and a formal policy evaluation plan to ensure the CCCEA achieves its goal of cancer equity in California.