Lung cancer kills more people in the United States than any other cancer, and each year Florida has among the most lung cancer deaths in the country. As with any other disease, early diagnosis usually provides better treatment options and outcomes.
Now, researchers at the University of Miami’s Sylvester Comprehensive Cancer Center believe they have identified a factor that can enhance early detection for minority groups that suffer disproportionately from the disease: A diverse medical workforce.
In a study published last August in the Journal of the National Cancer Institute, researchers crunched state data on non-small cell lung cancer diagnoses from 2015-18, comparing people in Miami-Dade, Palm Beach, Broward and Monroe counties with the rest of Florida. They found that Hispanics living in South Florida get diagnosed at about the same stage as white people in the region.
But in the rest of the state, Hispanic patients were diagnosed at later stages. Black patients lagged whites throughout the state and are 33% more likely to be diagnosed in advanced stages compared to white people.
Non-Hispanic white patients are well represented within South Florida’s medical workforce, says UM epidemiologist and study leader Paulo Pinheiro, and a cultural alignment between patients and providers likely accounts for the difference.
“Effective early detection relies on timely health care access, suggesting that Hispanic and other minority populations could benefit from culturally sensitive health care and strong community support,” Pinheiro says. “In South Florida, these groups experience a unique advantage due to a cohesive social network and a more diverse, culturally aligned health care workforce — a model that could improve outcomes for other screenable cancers compared to the rest of the state.”
Sylvester Center staff see these factors play out among their own practices, he says. Sylvester is South Florida’s only NCI-designated cancer center, and it has a high representation of Hispanic health care providers.
Patients who see medical professionals reflecting their own “cultural and linguistic backgrounds” develop greater “comfort, trust and proactive health-seeking behaviors,” Pinheiro says. The findings should be heeded “in other regions with diverse populations.”
These disparities in diagnosis timing are significant because they affect treatments and outcomes. Other factors can hurt minority mortality rates, including lower income levels, insurance and access to quality care. “Additionally, implicit biases within the health care system can affect patient-provider communication, leading to mistrust and lower adherence to treatment recommendations,” Pinheiro says.
Later diagnoses also carry a ripple effect that goes far beyond the individual patient. Treatment is more complex and expensive, further straining the health care system. They take people out of the workforce and increase families’ financial burdens.
Pinheiro recommends that providers outside of South Florida provide more translation services and multilingual educational materials along with beefing up community-based health initiatives targeting Black and Hispanic communities to increase awareness of cancer risks and the benefits of early screening.
Meanwhile, Pinheiro also is looking at disparities within liver cancer diagnoses, where risk factors are similar and earlier intervention could have greater effects. Another member of the research team, Qinran Liu, is looking at other parts of the country to see whether racial segregation contributes to cancer staging disparities.