Researchers strive to eliminate inequities in cancer treatment

A middle-aged woman feels persistent pain in her lower abdomen and knows it could be a sign of ovarian cancer. But she lives in rural Texas — hours from the nearest cancer center.

A middle-aged man, a city dweller, knows about barriers to medical care. He has all the symptoms of prostate cancer, but every doctor he has called delivers the same message. No health insurance, no treatment.

An older Asian woman faces a different roadblock. She hesitates to mention her breast lump to friends or even her husband. At her age, in her culture, cancer is an embarrassment and a shame.

Lorna McNeill, Ph.D., chair of Health Disparities Research at MD Anderson, hears similar stories every day. Eliminating inequities in cancer treatment — be they triggered by race, poverty, geography, gender, sexual orientation or cultural training — is the monster goal of her department.

“I’m not talking about factors that are inherently genetic, but differences in the social fabric of our lives,” McNeill says. “It’s our job to study the causes of these disparities, then try to do something about them. We want everyone to have the same low chances of getting cancer and the same good outcomes.”

From her office in Pickens Academic Tower, McNeill ticks off just a few of her department’s projects, present and future:

• To reduce cancer risks in Houston’s Hispanic community, Larkin Strong, Ph.D., assistant professor of Health Disparities Research, is promoting physical activity and healthy eating as a path to weight loss. “Obesity contributes to a lot of different cancers,” McNeill explains. “As we make great strides in lowering mortality rates, obesity is increasing and blunting that progress.” McNeill also points to a correlation between poverty and obesity. “The more money people have, the more likely they are to be normal weight.”
• For the Asian women feeling isolated and ashamed by breast cancer, Qian Lu, M.D., Ph.D., associate professor of Health Disparities Research, helps them work through their traumatic experiences with a writing project similar to journaling. One woman wrote in her prompted essay, “I don’t want to occupy too much of my mother’s time to make her worry. My husband takes care of me every day … how can I tell him how bad I feel to burden him and make him sad?” But by the end of the exercise, the woman clearly felt better. She concluded, “Thank you Dr. Lu for providing me this writing experience to make me feel warm and supported. You are the only person I can share my feelings with.”
• A new addition to the health disparities team, Surendranath Shastri, M.D., M.B.B.S., Dr.P.H., hopes to help low-income women self-test for human papillomavirus, or HPV, which can lead to cervical cancer. In the U.S., women with health insurance get pap tests, McNeill says. For those in developing countries without such resources, Shastri suggests a much cheaper diagnostic test that involves a visual inspection of the cervix after the application of contrast chemicals such as vinegar or iodine. Costing only about 30 cents per test, these inexpensive household tests highlight precancerous lesions if they exist.

Other projects of deep interest to McNeill include a win-win collaboration with MD Anderson and the University of Houston that’s aimed at reducing cancer rates and increasing survivorship among traditionally underserved populations. The project, called the UHAND Partnership, pairs University of Houston students and junior faculty with mentors from UH, MD Anderson and community organizations, so they gain invaluable research and “in the trenches” experience.

McNeill’s department also is working to ensure that a proportionate number of minorities participate in clinical trials, which often offer the best hope in cancer treatment. For a variety of reasons, however, African-Americans, Hispanics, Asians and women are poorly represented.

The department still has much work to do, McNeill says. But she is inspired daily by her Jamaican grandmother, who died of breast cancer at 52 and left behind a husband and nine children.

“She was very poor, and at that time and place, if you got cancer, you died of cancer,” McNeill says. “I just wish she could see me now.”