February 18, 2022
4 minute read
Knudsen KE. A way forward, a call to action: Addressing trends and disparities in genitourinary cancers. Presented at: ASCO Genitourinary Cancer Symposium; February 17-19, 2022; San Francisco.
Disclosures: Knudsen does not report any relevant financial information.
SAN FRANCISCO — Tackling disparities in genitourinary cancers requires more research into changing risk factors and immediate actions aimed at prevention, Karen E. Knudsen, PhD, MBA, said at the ASCO Symposium on Genitourinary Cancers.
Knudsen – who last year became CEO of the American Cancer Society and its advocacy affiliate, American Cancer Society Cancer Action Network – used her keynote address at the symposium to highlight trends in incidence and genitourinary cancer mortality in the United States, as well as priorities for the field.
More than 3.5 million cancer deaths have been averted since 1991 following a “doubling of investment in cancer research,” Knudsen said.
“Still, we are not entirely satisfied,” she added. “We know, even as we celebrate this 32% reduction in cancer mortality, that progress has not benefited everyone. … We still have a lot of work to do.
Karen E. Knudsen
Known sources of racial disparities in cancer outcomes include lack of transportation, need for housing near cancer centers, lack of health and digital literacy, hesitancy to enroll in clinical trials and unconscious bias among providers and health systems.
“Let’s take those truths that we know exist and go beyond implementation strategies,” she said.
Genitourinary cancers, which account for more than 20% of new cancer cases each year, pose a significant problem, Knudsen said. Prostate and bladder cancers alone are responsible for 14.4% of all cancer deaths in men, she added.
Disparities in bladder cancer include four times higher incidence and three to four times higher mortality in men than in women. This pattern is distinct from lung cancer profiles, which show gender convergence, Knudsen said.
Meanwhile, death rates have steadily declined among black men while remaining higher among white men, again different from lung cancer trends.
“From research, we can ask ourselves in terms of risk factors, is there something we’re missing?” Knudsen said. “We also know that there is currently no screening method for people at average risk. We are also watching the development of tests for the early detection of several cancers, and we look forward to strong evidence that these tests actually show clinical benefit.
Strategies that could be implemented immediately include increased smoking cessation efforts, she said.
The long-term increase in the incidence of kidney cancer — mostly from diagnoses at the localized stage — can be attributed in part to the incidental detection of asymptomatic tumors through increased medical imaging, Knudsen said.
“There is a slow but steady increase by gender [and] demographic, so different from what we’ve seen with bladder cancer,” she said. “We suggest that the call to action here, in fact, is prevention, because approximately half of kidney cancers that are reported now can be prevented by eliminating important risk factors for this disease. [These] include being overweight and smoking.
Kidney cancer mortality, which has been declining since the mid-1990s, has remained relatively stable among black men despite their higher incidence rate, while increasing among both men and women.
Research should seek to identify the basis for the discrepancy in incidence and mortality among black men and lower incidence among Asian/Pacific Islanders, as well as additional risk factors, Knudsen said.
She suggested promoting healthy lifestyles and prevention strategies as immediate steps that can be taken.
Prostate cancer incidence dropped significantly following US Preventive Services Task Force recommendation against screening; however, it remains 73% higher among black men than among white men. The reasons for this difference remain unknown, Knudsen said.
Testing rates among black men and white men in the United States are roughly equal but remarkably low, she said.
“Although they are fair, I don’t think we can celebrate a third of the men [undergoing] prostate cancer screening,” Knudsen said.
A slight increase in the incidence of localized stage and regional stage disease occurred after readjustment of screening guidelines, but the most dramatic change was seen in distant stage disease, which increased by 4 % to 6% per year since 2011.
“For us at the American Cancer Society, this is a call to arms,” Knudsen said.
The steep declines in death rates in all groups since the mid-1990s are starting to flatten out, which may indicate testing saturation or a need for new therapeutic strategies, Knudsen said.
His calls to action included refining screening and stepping up the search for new therapeutic strategies.
A review of regional differences in prostate cancer incidence and mortality in the United States revealed striking variations that should be investigated, Knudsen said. For example, incidence and mortality rates appeared to be balanced in Florida, while California had the lowest incidence but the highest mortality. In the Carolinas, black men had significantly higher death rates than white men, while in New York and Texas, black men and white men had equal outcomes.
“We know part of that is access to care,” Knudsen said.
Knudsen suggested the adoption of evidence-based screening to reverse the diagnostic shift to more advanced disease. She also highlighted the need for efforts to address disparities in outcomes by region and demographic group, the underuse of germline testing in localized disease, and variations in clinical trial uptake.
The incidence of testicular cancer increased for all subgroups, but Knudsen described the increase in incidence and mortality among Hispanics as alarming.
“There’s a big call to action here too, to increase testing, to increase awareness and to really understand the risk factors,” she said.
Regional variations have been identified across the country. For example, Louisiana has balanced testicular cancer incidence and mortality rates, while Arizona has the lowest incidence and highest mortality.
Understanding the basis for these variations should be a research priority, Knudsen said. “But right now we can increase awareness and we can increase uptake of testing,” she said. “I will flag to you, as CEO of the American Cancer Society, now that we have come to this realization, we will be part of this solution in states that have this high incidence.”