How Can Cancer Risk Be Cut in Communities Exposed to Toxins?

Group outlines plan to bring the latest testing and treatment to medically underserved minorities.

WASHINGTON — The rate of lung cancer in the general U.S. population was well under 1% in 2022, according to the American Cancer Society, but among a cluster of 75 people in Houston, Texas’s Fifth Ward, the rate is … 57%.

Part of the reason for that is thought to be due to creosote used as a wood preservative by the Union Pacific Railroad in the 1950s in a rail yard near the community, Letitia Plummer, an at-large member of the Houston City Council, told MedPage Today Wednesday following a press briefing here sponsored by the National Minority Quality Forum (NMQF). “That creosote just kind of went into the ground, and it created a ‘plume’ that’s been there since the early ’50s,” she said. “And so everyone in that Fifth Ward community has been affected negatively by that.”

In addition to lung cancer, the Fifth Ward, which is primarily Black and Hispanic, has similarly high rates of other cancers, including a 47% incidence of colorectal cancer, as well as high rates of multiple myeloma and Hodgkin’s lymphoma, Plummer said during the briefing. The city is looking at a relocation plan for the residents but is awaiting due diligence from the Environmental Protection Agency, she told MedPage Today, noting that the idea of relocation raises many questions.

“Are people getting cancer because of the initial exposure? Is there some level of genetic involvement that’s happening, and that’s why we’re seeing generations of people being born or have cancer?” Plummer said. “Is there a recurrent, actual, immediate concern or risk for the people that are there? And how do we give them the screening that they need?”

“If they do have cancer, how do we give them the continuum of care, transportation — resources to be able to treat the cancer that they currently have?” she continued. “And if it’s not a current risk, how do we make that community whole? Do we relocate them, move them out of the community that they’ve been raised in and were born in? … We’re just really trying to figure all that out.”

Wednesday’s press conference was aimed at tackling many of those questions for the Fifth Ward and similarly affected minority communities across the country, NMQF President Gary Puckrein, PhD, said at the press event. “Sixty percent of Blacks live in communities with one or more abandoned toxic waste sites. Three of the five largest commercial hazardous waste plants are located predominantly in African-American and Latino communities.”

“In these communities, public policy has elevated the risk of cancer through exposure to hazardous waste,” he continued. “Public policy has also denied them access to the best modern cancer care.”

“We have seen substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades, but communities marginalized by low economic status and environmental exposure have been slow to see the benefits,” said Puckrein. “Rural white communities tend to exhibit higher cancer death rates, less frequent use of proven screening tests, and have higher rates of advanced cancer diagnosis. Statistics reveal that Blacks have the highest death rate and shortest survival for most cancers. Cancer screening is disproportionately lower in Hispanic, Asian, and American Indian communities when compared to affluent communities. Pent-up frustration in medically underserved cancer care communities has eroded trust in their healthcare system, leading to the late-stage diagnosis of cancer … This state of affairs is unacceptable.”

On Wednesday, Puckrein’s group released a report it sent to President Biden’s Cancer Moonshot team highlighting the issue and urging the administration to take action. The report also outlines the Cancer Stage Shifting Initiative that the NMQF is launching in partnership with the CEO Roundtable on Cancer. The initiative aims to push peer-reviewed articles documenting the existence of medically underserved cancer care communities; publish a geographical index of such communities that includes incidence and prevalence of cancer types, rates of healthcare use, and cost of care; and conduct a pilot study to develop scalable cancer care protocols and payment models.

The pilot study has three parts, Puckrein told MedPage Today in an interview. “There are screenings now that will detect lung cancer before the patient is symptomatic,” he said. “So we want to take that technology into [places like] the Fifth Ward and screen folks to see if they have early-stage lung cancer [as well as other cancers]. So that’s the first arm of the study.”

“If we pick up a signal, we navigate them into the second arm of the study, in which we either put them into a clinical trial or get them into the best modern therapy,” Puckrein continued. “And the third arm of the study is to figure out what all of that costs, from the screening all the way to survivorship, so we have a financial model that allows us to go back to Congress and say, ‘You think you can’t pay for this, but here’s what it really costs.'”

“By pulling together the new technology, the science, and the cost, we co-create a model we can move around the country,” he explained. “Right now, the clinical and the financial, they’re not tied together. We want to do that, and we want to do it in high-risk communities because those are the ones where people can’t pay out of pocket and can’t get access, so their survival rates are poor.”

The science behind newer diagnostic and treatment modalities “is impeccable,” he added. “What’s broken is our ability to harness it and bring it into these communities.”