Building Toward Antiracist Cancer Research and Practice: The Case of Precision Medicine.

Understanding biological differences between different racial groups of human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma (OPSCC) patients, who have differences in terms of incidence, survival, and tumor morphology, can facilitate accurate prognostic biomarkers, which can help develop personalized treatment strategies.

Image analysis reveals differences in tumor multinucleations in Black and White patients with human papillomavirus‐associated oropharyngeal squamous cell carcinoma

Inclusion and diversity in precision oncology are essential in reducing cancer disparities among racial and ethnic groups. However, present studies have favored the recruitment and participation of whites, with limited applicability of their results to minority groups. Many reasons for their underrepresentation are downstream manifestations of structural racism. Therefore, this scoping review provides a precise mapping of recruitment and participation barriers for minorities in precision oncology that are associated with structural racism, including a critical appraisal of how disciplinary norms, paradigms and tools used therein could inadvertently contribute to unforeseen inclusion and diversity challenges. Methods Empirical and theoretical publications from Web of Science and PubMed were searched and analyzed to identify recruitment and participation barriers for minorities in precision oncology. In addition, using the Public Health Critical Race Praxis (PHCRP) as guiding analytical framework, empirical studies were analyzed to identify unforeseen barriers resulting from simplification processes, assumptions, norms, paradigms and tools used during the research process. They namely individual, the lower they should from researchers and healthcare professionals to policy-makers, research committees, and funders.

/pdf/impact-of-structural-racism-on-inclusion-and-diversity-in-8zf8cg41.pdf

Impact of structural racism on inclusion and diversity in precision oncology: a scoping and critical review of the literature

Patients with human papillomavirus‐associated oropharyngeal squamous cell carcinoma (HPV‐OPSCC) have a favorable prognosis and excellent overall survival (OS), and studies have demonstrated these findings in cohorts of predominantly White patients. Racial/ethnic (R/E) minorities, particularly Black patients, with head and neck squamous cell carcinoma (HNSCC) have worse survival outcomes compared with White patients. In this study, we aimed to determine if Black patients with HPV‐OPSCC have a similar favorable prognosis to the White population. This was a population‐based retrospective cohort study that analyzed HNSCC patients using the National Cancer Database from 2010 to 2016. We identified patients with Stage I–IV HPV‐ OPSCC who were treated with radiation, surgery, chemotherapy, or a combination of modalities. Patient outcomes were stratified by R/E groups including White Versus Black patients. The main outcome in this study was OS. Analyses for proportions of categorical variables were performed using a χ2 or Fisher's exact test. Univariate and multivariate time‐to‐event survival analyses were performed using Kaplan–Meier product limit estimates and log‐rank test to test the differences between strata. A Cox proportional hazards regression model was used to assess the association between covariates and risk of death (OS). We identified 9256 OPSCC patients who met inclusion criteria and were treated between 2010 and 2016, of which 7912 were White (85.5%) and 1344 were Black (14.5%). A total of 1727 were HPV‐OPSCC, of which 1598 were White (92.5%) and 129 (7.5%) were Black. By race, the 5‐year OS for White versus Black OPSCC patients was 42% versus 23%, respectively (log‐rank, p < 0.0001). Among HPV‐positive OPSCC patients, the 5‐year OS for White versus Black patients was 65% versus 39% (log‐rank, p < 0.0001). Among HPV‐negative patients, the 5‐year OS for White versus Black patients was 36% versus 13% (log‐rank, p < 0.0001). On multivariate analysis, after accounting for age, sex, insurance status, income, Charlson–Deyo score, receipt of surgery, distance from facility, and total treatment time, Black race trended toward, but was not associated with worse survival. Hazard ratio (HR:1.24, 95% confidence interval [CI] 0.85–1.81, p = 0.255). This national cohort study of OPSCC patients demonstrates that Black patients with HPV‐OPSCC have a poor prognosis and OS similar to HPV‐negative White patients. This may be partly due to socioeconomic barriers such as insurance and income. Further work is needed to better understand the specific drivers of inferior survival outcomes in this specific patient population.

Disparities in survival outcomes among Black patients with HPV‐associated oropharyngeal cancer

Health Equity for Black Americans: The Past Cannot Be Prologue

African Americans With p16+ and p16- Oropharyngeal Squamous Cell Carcinomas Have Distinctly Poor Treatment Outcomes Independent of Medical Care Access.

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African Americans With p16+ and p16- Oropharyngeal Squamous Cell Carcinomas Have Distinctly Poor Treatment Outcomes Independent of Medical Care Access.