According to the National Cancer Institute (NCI), cancer health disparities are adverse differences between certain groups of people in measures, such as: incidence (new cases), prevalence (all existing cases), morbidity (cancer-related health complications), mortality (deaths), survivorship and quality of life after cancer treatment, burden of cancer or related health conditions, screening rates and stage at diagnosis. Populations of focus may be characterized by race, ethnicity, disability, gender and sexual identity, geographic location, income, education and other characteristics. Generally, people from low socioeconomic backgrounds (with low or no income, education less than high school, and other social disadvantages) often bear a greater burden of disease than the general U.S. population, among many other reasons because they may lack health insurance and have limited or no access to effective health care (NCI). Similarly, individuals from underrepresented backgrounds also bear a disproportionate burden of disease than those considered in the majority population or the “dominant culture.” In the U.S, underrepresented minority populations are defined as African Americans (Black), American Indians/Alaska Natives and Latinos, who have historically comprised a minority of the U.S. population.
Cancer disparities in Massey’s catchment area
A catchment area, as defined by the National Cancer Institute, is the geographic area and population from which a cancer center draws patients. Defining a catchment area allows a cancer center to describe its primary patient population and assess how well it meets the needs of cancer patients within the catchment area. MCC defines its catchment area as 65 contiguous localities in the central, eastern, and southern areas of Virginia. This catchment area was estimated probabilistically, and includes over 90% of MCC’s new cancer cases. These 65 localities are home to approximately 4 million racially, ethnically, geographically and socioeconomically diverse individuals, across nearly 19,000 square miles, with 41% of residents identifying as racial/ethnic minorities and 52% identifying as living in rural areas. In fact, MCC’s catchment area includes 12 of Virginia’s 21 completely rural localities (based on the rural-urban continuum codes, RUCC 8-9). The catchment area also includes 16 of Virginia’s 20 majority-minority localities. Collectively, over 90 percent of patients diagnosed at Massey between 2012 and 2017 resided within this area. Given VCU Health’s commitment as a safety-net health care system, which means that it provides a significant level of care to low-income, uninsured and vulnerable populations, it is not surprising that cancer patients diagnosed at MCC are more likely to be minority, female, uninsured, or on Medicaid.
Significant cancer disparities exist within VCU Massey Cancer Center’s catchment area. Cancer incidence and mortality rates in the MCC catchment area are among the highest in Virginia. Eighteen of the 26 localities with the highest cancer incidence rates among Black Americans in the state of Virginia are within the MCC catchment area. Overall, cancer incidence and mortality for the MCC catchment area are slightly higher than the U.S., regardless of geography (rural or urban; Fig. 1). The excess incidence and mortality relative to the U.S. seem predominantly driven by higher incidence for breast, lung, and prostate cancers and higher mortality for lung cancer.
- Urban: Stratified by geography, the excess incidence of Breast Cancer (BCa) in the catchment area seems driven by higher BCa incidence rates among urban localities compared to rural; likewise, higher BCa mortality seems most evident among the urban localities. Prostate Cancer follows the same pattern with higher incidence and mortality in urban localities relative to rural.
- Rural: By contrast, Lung Cancer excess incidence and mortality is most pronounced in rural compared to urban localities in the catchment. MCC’s catchment area also includes a known hot spot for Colorectal Cancer in the rural Southern regions of Virginia, evident particularly when compared to the rural localities in the reported incidence and mortality averages.
Stratified by race (Fig. 2) and relative to U.S. Blacks, Blacks in MCC’s catchment experience slightly elevated cancer incidence and mortality. The elevated incidence among Blacks in MCC’s catchment relative to U.S. Blacks seems partly due to excess incidence of breast and prostate cancers. Compared to U.S. Blacks, MCC catchment area Blacks do not experience higher mortality.
However, compared to Whites in the catchment, Blacks experience higher incidence of colon (42 vs. 37) and prostate (178 vs. 91) and higher mortality for breast, colon, and prostate cancers. Of note, while there is no apparent excess mortality among Black catchment area residents relative to U.S. Blacks, a closer look reveals that for 9 cancer types, the localities with the highest mortality statewide are catchment area localities with a Black population of >30%:
- Martinsville has the highest overall cancer mortality in the state of Virginia (268) and highest mortality for colon (34) and lung (87);
- Petersburg has the highest mortality for bladder (9) and prostate (52);
- Northampton has the highest mortality for pancreatic (23), followed by Martinsville (21).
In fact, the MCC catchment area has a higher mortality rate than the U.S. or Virginia for 14 of the 21 reported cancers in state cancer profiles.
While it is not represented graphically here, cancer incidence and mortality rates for MCC catchment area Latinx residents (~7% of the MCC catchment area) were compared to their U.S. counterparts with no salient cancer rates identified. However, MCC catchment area Latinx residents had more than double the BCa incidence than Latinx Virginians living outside of the catchment area (43 vs 20), 50% higher lung cancer incidence (9 vs 6) and nearly 3 times the overall cancer mortality relative to their non-catchment area Latinx Virginians (4 vs 23). In fact, the 65 MCC catchment area localities in general have worse cancer outcomes than the 58 Virginia localities not included in the MCC catchment area (data not shown).
Addressing disparities in Massey’s catchment area
VCU Massey Cancer Center offers programming within our catchment area, and due to strong community partnerships, we have been able to leverage programming, services and research beyond this defined area and extend them to Danville and other areas.