Cancer development, treatment, and outcomes are tricky topics to understand. The underlying reasons why a person gets cancer or how they might respond to treatment are often unknown and depend on a variety of factors. Just as we can study different risk factors and treatments, we can study different characteristics of people with cancer. Learning more about the individuals getting cancer and their overall outcomes can help us develop new treatments and better identify those at risk.
Many different cancer characteristics have been studied in recent years. However, there has been a growing interest in learning more about race and ethnicity in relation to blood cancer. In honor of Minority Cancer Awareness Month, interesting findings from a few studies on the topic are below.
ALL: Latino people were the most likely to have ALL and Black people were the least likely. Asian and Pacific Islanders had the longest overall survival after diagnosis. Both Black and Latino people had the highest mortality rates.
AML: Minority groups were less likely to get AML than their White counterparts but had worse outcomes. Like ALL, the highest mortality rates were in Black and Latino people. Also, survival rates for AML were improving for all minority groups, with the exception of Latino people.
CML: White people had the highest rate of CML cases, while Latino people had the least. Even though they were less likely to get CML, Latino people had the highest 5-year survival rate. White people had the lowest.
CLL: When it came to 5-year survival, Black people had the lowest survival rate. White people had the highest survival rate. Additionally, stage IV overall survival was the longest for White people. Asian and Pacific Islanders may have the longest overall survival after a stage I diagnosis.
Childhood leukemia: ALL was the most common leukemia in children. Further, Latino children are at highest risk. Black and Latino children had the lowest chances of having a stem cell transplant. Black children also had the lowest probability of receiving chemotherapy. Asian and Pacific Islander children were typically the youngest at ALL diagnosis, while Black children were the oldest. For both AML and ALL, White children had the longest overall survival while Black children tended to have the shortest.1,2
When it came to treatment and cancer characteristics, there were also differences among racial and ethnic groups. In AML, Black and Latino people were less likely to receive a stem cell transplant. White people and Asian and Pacific Islanders were the most likely. The reasons for this are not well understood but may be related to there being fewer minority donors in the registry. It may not be that survival is actually worse for minorities with leukemia, but rather, treatment is not as accessible.1,2
In one study, lymphoma displayed similar trends to leukemia. When it came to Hodgkin lymphoma (HL) Black and Latino people:
Had a greater rate of mortality if they were under 44 years old.
Had lower 5-year survival rates than their White and Asian and Pacific Islander counterparts.
Were diagnosed at later stages of HL.
Had even worse survival if they came from lower financial backgrounds.2
Black people were diagnosed at younger ages and later stages than others.
Black people had the lowest rates of diffuse large B-cell lymphoma (DLBCL) but their 5-year survival rates after a stage I diagnosis was lower than other groups.
White people had the best 5-year survival rates for stage I and stage IV DLBCL diagnoses.
Asian and Pacific Islanders had the worst 5-year survival after a stage IV DLBCL diagnosis.
Black people were the least likely to receive chemotherapy.2
In a multiple myeloma-specific study, diagnosis, treatment, and outcomes also seemed to be worse for minority groups.3 Specifically, minorities were often diagnosed earlier in life, which is a sign of worse prognosis. Minority groups had other poorer prognostic factors, like obesity and anemia. Overall, Asian and Pacific Islanders had the longest overall survival with multiple myeloma, while Latino people had the shortest.2,3
As with other types of blood cancers, stem cell transplant seemed to be utilized more frequently by White people than minority groups.3 Additionally, it was found that minority groups may make up less than 20 percent of clinical trial participants. These trials may provide life-extending treatment options to those in need. This could also be a reason why White people with multiple myeloma might use newer treatment options more frequently.3
What does it all mean?
Overall, these results suggest that there are differences in cancer development, diagnosis, and survival with blood cancer between racial and ethnic groups. The reasons for this are not well understood, and may be related to a variety of different factors. Some of these may be related to genetics, environmental or work exposures, social factors, financial issues, lifestyle practices, diet, access to healthcare and helpful resources, and more. Minority involvement in life-extending clinical trials may also be low. This may be preventing some groups from receiving critical care.
This is such an important topic to talk about, as differences in treatment options, high mortality rates, and more aggressive cancers can take a huge toll on quality of life. However, this information is only from a few studies, and much more research is needed to understand the factors at play. For the time being, studies like these can help call out the differences in general and may help doctors better diagnose and treat people from all backgrounds.
Resources for minority groups with blood cancer
This information may seem overwhelming and confusing. Especially for individuals belonging to minority groups that appear to have worse outcomes. It is okay to ask for help and support as you navigate your journey.
While some large organizations have resources designed for everyone living with blood cancer, there are some minority-specific organizations that can help as well. Several resources to consider if you or a loved one with blood cancer belongs to a minority group include the following:
Zhao Y, Wang Y, Ma S. Racial differences in four leukemia subtypes: Comprehensive descriptive epidemiology. Nature: Scientific Reports. 11 Jan 2018; 8, 548. Available at: https://www.nature.com/articles/s41598-017-19081-4. Accessed March 5, 2020.
Kirtane K, Lee SJ. Racial and ethnic disparities in hematologic malignancies. Blood. 12 Oct 2017; 130(15), 1699-1705. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639484/. Accessed March 5, 2020.
Ailawadhi S, Jacobus S, et al. Blood Cancer Journal. Jul 2018; 8(7), 67. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035273/. Accessed March 5, 2020.