Is Philadelphia Advancing in the War Against Cancer?

As recent racial justice protests and the ongoing coronavirus pandemic illuminate the role that structural racism and socioeconomic factors play in the health of Americans, significant disparities may be found in cancer rates and outcomes, according to "State of Cancer in Philadelphia," a report issued this week from Drexel University Urban Health Collaborative, the Philadelphia Department of Public Health, and Fox Chase Cancer Center, sponsored by Lazarex Cancer Foundation. The analysis offers key information to public health agencies, policymakers and care providers to inform how best to allocate resources to promote health equity in Philadelphia. It is also the first report of its kind to give a comprehensive interactive overview of cancer incidence, screening and mortality data in Philadelphia by race/ethnicity and sex for different cancer types.

As recent racial justice protests and the ongoing coronavirus pandemic illuminate the role that structural racism and socioeconomic factors play in the health of Americans, significant disparities may be found in cancer rates and outcomes, according to “State of Cancer in Philadelphia,” a report issued this week from Drexel University’s Urban Health Collaborative, the Philadelphia Department of Public Health, and Fox Chase Cancer Center, sponsored by Lazarex Cancer Foundation. The analysis offers key information to public health agencies, policymakers and care providers to inform how best to allocate resources to promote health equity in Philadelphia. It is also the first report of its kind to give a comprehensive interactive overview of cancer incidence, screening and mortality data in Philadelphia by race/ethnicity and sex for different cancer types.

The team looked at the number of cancer cases and deaths from 2000-2016 from the Pennsylvania Department of Health Cancer Registry and the Vital Statistics Registry from the Pennsylvania Department of Health’s Bureau of Health Statistics & Registries. For statistics on cancer screening and risk factors, such as race and education level, the report draws from nine surveys conducted between 2000 and 2018 by the Southeastern Pennsylvania Household Health Survey from the Public Health Management Corporation.

The report gives a broad and detailed look at how cancer, and its risk factors, have changed over the past 10 years and how they vary by race, ethnicity and socioeconomic factors.

Although incidence and mortality rates for many cancers have been decreasing over the past few years, liver cancer incidence and mortality have increased in men and women. Breast cancer incidence and lung cancer incidence have increased in Black women.

Additionally, racial and socioeconomic disparities persist. Cancer mortality is higher for African Americans than for other racial/ethnic groups and is also higher in neighborhoods with lower levels of education compared to neighborhoods with higher levels of education.

Persons with lower education have significantly higher levels of cancer risk factors than those with more education. Although some cancer risk factors have improved in recent years, obesity, diabetes and binge drinking rates have increased and fruit and vegetable consumption remains at very low rates. Philadelphia residents, including Black men and women, reported high rates of screening for most common cancers.

“COVID-19 has reminded the world of the impact that social conditions, including those linked to race and socioeconomic factors, have on health,” said report contributor and Urban Health Collaborative Director Ana Diez Roux, MD, PhD, dean and distinguished professor of Epidemiology at Dornsife School of Public Health. “It’s no surprise that cancer and its risk factors are also strongly socially patterned. Fortunately, we now have hard data to guide efforts to prevent cancer and improve cancer survival in the social groups most affected.”

The authors call for programs and policies that reduce disparities by creating conditions that make healthy lifestyles easier — decreasing the concentration of tobacco and junk food marketing in Black and Latino neighborhoods and increasing the affordability and accessibility of healthy foods and safe, affordable spaces to be physically active — as well as initiatives that provide universal access to cancer screening and treatment.

“Public health research into the factors that underlie high rates of cancer mortality among African Americans in Philadelphia despite high rates of cancer screening is urgently needed,” said report contributor Cheryl Bettigole, MD, director of the division of Chronic Disease and Injury Prevention at Philadelphia Department of Public Health. “Health disparities cannot be eliminated overnight, but we know that through consistent collaborations with our community and clinical partners we can advance towards better health for all Philadelphians.”

The research was supported by the Lazarex Cancer Foundation as part of the Community IMPACT project. The goal of Community IMPACT, a collaboration between Dornsife School of Public Health, Drexel College of Nursing and Health Professions and Lazarex is to improve understanding and awareness of the burden of cancer on patients and their families, and opportunities for the prevention and treatment of cancer for residents in minority and disadvantaged communities in Philadelphia.

In addition to Diez Roux and Bettigole, researchers contributing to the report include Binod Acharya, Taylor Andrews, Jim Buehler, MD, Sarah Greer, Katie Livengood, Steven Melly, Kari Moore, Gabrielle Mullin, Harrison Quick, PhD, and Heather Rollins, from Drexel’s Urban Health Collaborative, as well as Shannon Lynch, from Fox Chase Cancer Center and Raynard Washington of the Philadelphia Department of Public Health.

Read the full report here.