One in three people in the United States will receive a cancer diagnosis in their lifetime.i This means you, or someone you know, may someday be impacted. This disease does not discriminate. Unfortunately, many people face unnecessary barriers to timely and equitable screening, treatment and support.
To help close these gaps, the American Cancer Society (ACS) and Pfizer recently launched a new three-year initiative, “Change the Odds: Uniting to Improve Cancer Outcomes,” aimed at addressing cancer disparities and improving health outcomes in medically underrepresented communities across the United States. The initiative will initially focus on breast and prostate cancer, two of the most common types of cancer, with potential to expand in the future.
Dr. Karen E. Knudsen, Chief Executive Officer at ACS, and Chris Boshoff, Chief Oncology Officer and Executive Vice President at Pfizer, share their perspectives on the importance of working together so that everyone, regardless of their race, ethnicity or where they live, have equal opportunity to access the care they deserve.
Q: Can you share an update on the scientific progress that has been made in cancer care?
Chris Boshoff: The progress that the Oncology community has made is nothing short of remarkable. Thirty years ago, our toolbox was limited to early chemotherapies, surgeries, and radiation treatments, which had limited efficacy and placed significant physical, mental and emotional burden on people with cancer and their families. For many, a cancer diagnosis was an automatic death sentence.
Today we are at the cusp of a new era in cancer care. Thanks to a recent surge in Oncology R&D, new clinical trial starts reached historically high levels in 2021.i Coupled with technological breakthroughs, cutting-edge scientific innovations are bringing us closer than ever before to long-awaited cures for certain cancers.
Although cancer is still a leading cause of death, the risk of dying from cancer has slowly decreased over the last few decades, thanks to improved awareness, earlier detection and advances in treatment.iii,iv For certain cancers, the progress has been dramatic: for example, the death rate for chronic myeloid leukemia, a cancer of the blood and bone marrow, declined by 70 percent between 1975 and 2020.v
But everyone has not benefited equally from these advances. Too many people are being left behind due to barriers to timely cancer screening and diagnosis. We must continue to not only push science and technology forward, but also work to ensure more equitable access to these innovations and meaningful support to help navigate care in all communities.
Q: What are some of the disparities that exist in cancer care?
Dr. Karen E. Knudsen: Certain communities – including people of color, those with lower socioeconomic status (SES) and people living in rural areas – have limited access to quality healthcare, which greatly impacts their ability to detect cancer early. Later cancer diagnosis is tied to poorer outcomes, leading to significant health disparities for these communities.
Obstacles to screening can include structural barriers, such as lack of transportation, health literacy challenges or shortages of healthcare providers; insurance coverage and costs; and cultural barriers, including lack of language services, low awareness, distrust of medical institutions and poor patient-physician communication.vi
Breast and prostate cancer are not only the most common cancers in women and men, but they are on the rise – even as rates of other cancers are declining.vii,viii They also reflect significant disparities. Consider this: Although breast cancer screening rates for Black and White women are similar, Black women are twice as likely to be diagnosed at a later stageix and have a 40% higher mortality rate than White women.x Similarly, Hispanic women are more likely to be diagnosed with later-staged breast cancer in comparison to White women.xi In prostate cancer, although Black men are at higher risk for the disease, they are less likely to be screenedxii and more likely to be diagnosed at an advanced stage than other racial or ethnic groups. Their mortality rates are even more alarming: Black men are over two times more likely to die from the disease than White, Hispanic or Asian American/Pacific Islander men.iv
Beyond race and ethnicity, SES and geography also contribute to cancer disparities. Those with a lower SES or who live in rural areas face significant obstacles to accessing screening and care if diagnosed.xiii These obstacles include lower awareness of the benefits of early detection, health literacy challenges, shortages of healthcare providers and transportation challenges, all of which contribute to later diagnosis and higher cancer mortality rates for these communities.xiv
Q. How can improving clinical trial diversity help achieve equity in cancer care?
Chris Boshoff: Increasing diversity in clinical trials is a critical step to addressing disparities in care from the beginning of a medicine’s lifecycle. Although many cancers disproportionately impact ethnic and racial minority groups in both incidence and outcome, these groups are often underrepresented in clinical trials.ix Geographic proximity, language barriers, limited awareness, cost or insurance concerns, and lack of trust in the medical community and drug development process are all contributing factors.xv
Increasing diversity in clinical trials can help ensure the drug development and evidence generation processes are reflective of those most impacted by the disease, as well as help medically underserved communities gain access to the newest scientific advances. There are many actions a clinical trial sponsor can take to help achieve this goal, including selecting trial sites in communities where a disease is particularly prevalent, providing culturally and linguistically appropriate materials, and embracing digital tools to foster participation when frequent transportation to a clinical trial site is a challenge.
Partnerships with advocacy groups and other local leaders are invaluable to helping educate, build trust and remove barriers to clinical trial participation. Through these partnerships, we can empower patients from historically underrepresented communities to learn about clinical trial opportunities and start to improve diversity in drug research and development – and ultimately, help ensure equitable outcomes for all patients.
Q. Can you share more about “Change the Odds” and what you hope to achieve?
Dr. Karen E. Knudsen: Our goal with “Change the Odds” is to make a tangible, sustainable difference in communities that are disproportionately impacted by cancer, but medically underserved. We are starting by focusing on breast and prostate cancer given their significant impact, but hope to expand to additional cancer types, as well as engage additional partners, to help reach as many people as possible.
Improving cancer outcomes starts with early detection. ACS will leverage our broad network as well as engage partners on-the-ground in select communities to connect individuals and promote awareness of no- and low-cost screening opportunities. Our goal is to reach people where they are with these services and link them to appropriate follow-up and support. The funding contributed by Pfizer will help us amplify our ongoing screening efforts and hopefully make a significant impact in these communities.
No one should have to face a cancer diagnosis alone. Particularly for the communities we are trying to reach, support is critical to helping overcome barriers that may prevent them from getting quality care and the help they need during and after treatment. “Change the Odds” will raise awareness and help connect patients with ACS’ extensive evidence-based patient navigation programs, which provide individualized guidance and support for patients, families and caregivers to help navigate the complexities of their cancer journey.
As part of the initiative, we will also enhance overall awareness about clinical trials and work to empower patients with information about clinical trial participation opportunities generally, and work to address potential barriers to participation. Our goal is to not only improve representation of these communities in clinical trials, but also enhance access to the latest scientific advances, regardless of the trial sponsor.
Our vision at ACS is to end cancer as we know it, for everyone – including underrepresented communities and those who are currently facing barriers to support and care. We believe we can achieve this goal by partnering with organizations like Pfizer who share in this vision.
Q. What role does collaboration play in addressing disparities in cancer care?
Chris Boshoff: It’s clear that no one individual or organization alone can tackle the substantial disparities that exist in cancer care. It will take partnership across the entire healthcare ecosystem, at every touchpoint along the patient journey, to make a real difference for people with cancer.
Cancer doesn’t discriminate – and at Pfizer, we believe that neither should cancer care. Everyone should have equal opportunity to detect cancer early and access scientific advances. We’re proud to partner with ACS on a broad, community-focused initiative to reach people living with cancer where they are, with urgency, and connect them to resources to receive the care they deserve. We believe that together, we can outdo cancer – and change the trajectory of this disease as we know it.
To learn more about Change the Odds, visit www.cancer.org/ChangeTheOdds
iCenter for Chronic Disease Prevention. Cancer Fact Sheet
iiIQVIA. Global Oncology Trends 2022
iiiAmerican Cancer Society. 2024 Cancer Facts & Figures Summary Article
ivAmerican Cancer Society. Cancer Facts & Figures 2024 Report
vAmerican Association for Cancer Research. Cancer in 2023
viAmerican Cancer Society. Disparities in Cancer Screening and Early Detection
viiAmerican Cancer Society. https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html
viiiAmerican Cancer Society. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
ixAmerican Cancer Society. Cancer Facts & Figures for African Americans 2022-2024
xAmerican Cancer Society. Cancer Disparities in the Black Community
xiAmerican Cancer Society. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-hispanics-and-latinos/hispanic-latino-2021-2023-cancer-facts-and-figures.pdf
xiiAmerican Association for Cancer Research. Disparities in Cancer Screening for Early Detection
xiiiHenley (Cancer Epidemiol Biomarkers 2018)
xivYabroff (JCO Oncology Practice 2020)
xvHamel, Lauren M et al. “Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer.” Cancer control: journal of the Moffitt Cancer Center vol. 23,4 (2016): 327-337. doi:10.1177/107327481602300404