Cancer Inequities among African Americans: Who can you trust? Rena J. Pasick, DrPH Director, Community Outreach UCSF Helen Diller Family Comprehensive Cancer Center Professor, School of Medicine 5th Annual Florence Stroud Black History Nursing Conference Series Bay Area Black Nurses Association, Inc.

I was a stranger and you invited me in Matthew 25:35

UCSF “Abundant Life” Faith Communities Committee Established 2005

White African AmericanAsian Hispanic/ LatinoTotal Prostate * Colorectal Lung , All other 2,282.42,699.31,560.31,822.62,054.6 Age-adjusted Years of Life Lost Due to Cancer Alameda County Males Rate per 100,00 per year * African Americans die 20.3 years too young due to prostate cancer Source: Community Assessment, Planning, Education (CAPE) Data from Alameda County vital statistics files

San Francisco

Why? Discrimination/Racism Poverty Low quality education ↓ Stress Lifestyle (tobacco, diet, exercise) Inadequate health care Cancer kills Cancer starts

The long shadow of slavery

Ally: Someone who helps, defends or supports another; a partner L;koifhii h

I don’t want to be a guinea pig!!!!

Research: Good or Evil? Who can you trust?

Woe to those who call evil good and good evil, who put darkness for light and light for darkness, who put bitter for sweet and sweet for bitter! Isaiah 5:20

Highest income patients receive latest/best care Income inequality was associated with early adoption across clinical practices in two ways: similar to the diffusion of new and expensive technologies, residence in areas with high levels of income inequality was associated with higher use of the test. in areas with greater income inequality, the highest-income people may access a new technology first, even among insured women with the same coverage for gene expression profiling. For this and other tests of established value, “uneven diffusion by place and by population groups could drive an increase in health care disparities.” Gene Expression Profiling Ponce et al., Health Affairs 34,4(2015):

Equal treatment yields equal outcomes Differences in cancer treatment by setting/patient mix are well documented Adherence to NCCN guidelines studied in 30,000 CCR records of patients with CRC Compared adherence & outcomes in Integrated Hlth Sys (VA) vs other systems and across race/ethnicity Higher NCCN adherence in IHS vs other Minorities received higher level of evidence-based tx in IHS vs other Black race associated with higher mortality in non-IHS KF Rhoads et al., JCO 33, 2015

Research that reveals inequities in medical care: Good or Evil? Who can you trust?

Scientists learn how to target certain cancers Medicines work for some people and not others Medicines cause side effects in some people and not others People are different because of ancestry, lifestyle, environment and other factors Who can you trust?

Good Research or Evil Research ????

Cancer Treatment Trials People who take part in cancer research have better survival There is NO PLACEBO! This is how doctors learn what works best

2 nd Opinions for African American Women with Breast Cancer New Research Study Led by Rena Pasick, UCSF Can 2 nd opinions at UCSF improve the quality of treatment for low-income African American women with breast cancer? Free 2 nd opinions In person, by phone, or computer video Explain available clinical trials Review family history

Will you sign on?  Scientific discoveries will benefit those who participate  Otherwise, as science advances, disparities will grow Save lives by doing good…good research

 Questions?  Comments? Thank you !!!