Cancer Causes & Control

, Volume 28, Issue 9, pp 907–912 | Cite as

How will the ‘cancer moonshot’ impact health disparities?

Letter to the editor


In 1971, President Nixon signed into law the National Cancer Act (NCA), colloquially known as the “War on Cancer”, which pushed cancer onto the national agenda and is credited for many subsequent increases in the knowledge of the molecular, cellular, and genetic causes and effects of cancer. But even though cancer mortality has declined overall in intervening years after the NCA, cancer health disparities persist in the form of higher cancer incidence and mortality rates among certain cancer types and certain populations. Breast and cervical cancers disproportionately affect African American, Hispanic, and American Indian Women. Colorectal cancer is the second leading cause of death for Latinos (with men and women combined). Forty-five years after the NCA, how will the next enormous cancer initiatives—President Barack Obama’s Cancer Moonshot and the All of Us Research Program (formerly the Precision Medicine Initiative Cohort Program)—impact cancer health disparities? The emergence of precision medicine and the sharing of information across sectors are at the heart of these large national initiatives and hold vast potential to address complex health disparities that remain in incidence reporting, incidence, treatment, prognoses, and mortality among certain cancer types and racial/ethnic minorities, including African Americans and Hispanics/Latinos, compared to Whites. But clinical research efforts and data collection have historically lacked diverse representation for various reasons, posing a large risk to these national initiatives in their ability to develop diverse cohorts that adequately represent racial/ethnic minorities. Efforts to reduce disparities and increase diversity in study cohorts have emerged, from patient navigation, to use of mobile technology to collect data, to national consortiums dedicated to including diverse groups, to university training on health disparities. These efforts point to the need for the Cancer Moonshot and precision medicine leaders to develop a multifaceted approach to address disparities in health and healthcare to promote a diverse healthcare workforce, patient-centered care, maintenance of a database of information regarding the state of health disparities, and the institution of measurable goals for improving care across all ethnic groups. If these elements are included, it is possible that the Cancer Moonshot and precision medicine will benefit the entire population of our country.



The authors would like to acknowledge the support of the National Cancer Institute for the Cancer Therapy & Research Center (P30 CA054174) at the UT Health Science Center at San Antonio. The authors would also like to thank Erin Surette Dembeck, Eric Moreno, and Cliff Despres for their contributions to the preparation of this editorial.


The authors have no disclaimers. This study has not been presented elsewhere.


  1. 1.
    Welch HG, Schwartz LM, Woloshin S (2000) Are increasing 5-year survival rates evidence of success against cancer?. JAMA.
  2. 2.
    Institute of Medicine (US) (1999) In: Haynes MA, Smedley BD (eds) Committee on cancer research among minorities and the medically underserved. National Academies Press, Washington, DCGoogle Scholar
  3. 3.
    Rebbeck TR (2006) Conquering cancer disparities: new opportunities for cancer epidemiology, biomarker and prevention research. Cancer Epidemiol Biomark Prev 15:1569–1571CrossRefGoogle Scholar
  4. 4.
    Kolata G, Harris G (2016) ‘Moonshot’ to cure cancer, led by Biden, relies on outmoded view of disease. The New York Times. Accessed 23 Jan 2016
  5. 5.
    NCI and the precision medicine initiative. (2016) Accessed 28 Jan 2016
  6. 6.
    Associated Press in Philadelphia (2016) Joe Biden decries ‘cancer politics’ in kick-off of ‘moonshot’ to cure disease. The Guardian Accessed 26 Jan 2016
  7. 7.
    Disparities in Cancer Care (2006). J Oncol Pract 2(5): 234–239Google Scholar
  8. 8.
    Cancer health disparities: National Cancer Institute, NIH.
  9. 9.
  10. 10.
    Siegel RL, Miller KD, Goding-Sauer A, Pinheiro PS, Martinez-Tyson D, Jemal A (2015) Cancer statistics for Hispanics/Latinos, 2015. CA Cancer J Clin 65:457–480CrossRefPubMedGoogle Scholar
  11. 11.
    Davis JL, Ramos R, Rivera-Colon V et al (2014) The Yo me cuido program: addressing breast cancer screening and prevention among hispanic women. J Cancer Educ 30:439–446CrossRefGoogle Scholar
  12. 12.
    Ramirez A, Thompson I, Vela L (2013) A health disparities roadmap. South Tex Health Status Rev. doi: 10.1007/978-3-319-00233-0 CrossRefGoogle Scholar
  13. 13.
    Anderson GL, Barrington WE (2016) Narrowing of racial disparities in breast cancer incidence: insights from menopausal hormone therapy study findings. J Natl Cancer Inst 108(4):1–3CrossRefGoogle Scholar
  14. 14.
    Al-Alem U, Rauscher G, Shah E et al (2014) Association of genetic ancestry with breast cancer in ethnically diverse women from Chicago. PLoS ONE 9(11):e112916CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Connor AE, Baumgartner RN, Baumgartner KB et al (2015) Associations between ALOX, COX, and CRP polymorphisms and breast cancer among Hispanic and non-Hispanic white women: the breast cancer health disparities study. Mol Carcinog 54:1541–1553CrossRefPubMedGoogle Scholar
  16. 16.
    Carpenter WR, Tyree S, Wu Y et al (2012) A surveillance system for monitoring, public reporting, and improving minority access to cancer clinical trials. Clin Trials 9(4):426–435CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Nishi A, Milner DA, Giovannucci EL et al (2016) Integration of molecular pathology, epidemiology and social science for global precision medicine. Expert Rev Mol Diagn 16(1):11–23CrossRefPubMedGoogle Scholar
  18. 18.
    London L, Hurtado-de-Mendoza A, Song M, Nagirimadugu A, Luta G, Sheppard VB (2015) Motivators and barriers to Latinas’ participation in clinical trials: the role of contextual factors. Contemp Clin Trials 40:74–80CrossRefPubMedGoogle Scholar
  19. 19.
    Kwiatkowski K, Coe K, Bailar JC, Swanson GM (2013) Inclusion of minorities and women in cancer clinical trials, a decade later: have we improved? Cancer 119(16):2956–2963CrossRefPubMedGoogle Scholar
  20. 20.
    Dean M, Boland J, Yeager M et al (2015) Addressing health disparities in Hispanic breast cancer: accurate and inexpensive sequencing of BRCA1 and BRCA2. GigaScience 4:50CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Rangel LBA, Taraba JL, Frei CR, Smith L, Rodriguez G, Kuhn JG (2014) Pharmacogenomic diversity of tamoxifen metabolites and estrogen receptor genes in Hispanics and non-Hispanic whites with breast cancer. Breast Cancer Res Treat 148(3):571–580CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Popejoy, A. B., & Fullerton, S. M. (n.d.). Genomics is failing on diversity. Accessed 7 Jun 2017
  23. 23.
    Moyer VA (2014) Risk assessment, genetic counseling, and genetic testing for BRCA-related breast cancer in women: U.S. preventive services task force recommendation statement. Ann Intern Med 160:271–281PubMedGoogle Scholar
  24. 24.
    Chalela P, Pagan JA, Su D, Munoz E, Ramirez A (2012) Breast cancer genetic testing awareness, attitudes and intentions of Latinas living along the U.S. Mexico border: a qualitative study. J Community Med Health Educ 2:1–15Google Scholar
  25. 25.
    Ponce NA, Ko M, Liang SY et al (2015) Early diffusion of gene expression profiling in breast cancer patients associated with areas of high income inequality. Health Aff (Millwood). 34(4):609–615CrossRefPubMedGoogle Scholar
  26. 26.
    Lee JA, Roehrig CS, Duggan Butto E (2016) Cancer cost trends in the United States: 1998 to 2012. Cancer 122:1078–1084CrossRefPubMedGoogle Scholar
  27. 27.
    Dusetzina SB, Keating NL (2016) Mind the gap: why closing the doughnut hole is insufficient for increasing medicare beneficiary access to oral chemotherapy. J Clin Oncol 34(4):375–382CrossRefPubMedGoogle Scholar
  28. 28.
    Piana R (2014) Cancer care under the affordable care act.,-2014/cancer-care-under-the-affordable-care-act.aspx.. Accessed 27 Jan 2016
  29. 29.
    Kircher SM, Meeker CR, Nimeiri H et al (2016) The parity paradigm: can legislation help reduce the cost burden of oral anticancer medications? Value Health 19:88–98CrossRefPubMedGoogle Scholar
  30. 30.
    ASCO policy brief: cancer drug coverage parity act of 2015 (H.R. 2739/S.1566). Accessed 28 Jan 2016
  31. 31.
    Ko NY, Darnell JS, Calhoun E et al (2014) Can patient navigation improve receipt of recommended breast cancer care? Evidence from the national patient navigation research program. J Clin Oncol 32:2758–2764CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Braun KL, Stewart S, Bacquet C et al (2015) The national cancer institute’s community networks program initiative to reduce cancer health disparities: outcomes and lessons learned. Prog Community Health Partnersh 9:21–32CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Biggers A, Shi Y, Charlson J, Smith EC, Smallwood AJ, Nattinger AB, Laud PW, Neuner JM (2016) Medicare D subsidies and racial disparities in persistence and adherence with hormonal therapy. J Clin Oncol 34(36):4398–4404CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ingraham N Joe Biden implores SXSW crowd to use its talents to fight cancer,” endgadget.
  35. 35.
    Epidemiology and Genomics Research Program. National Cancer Institute, NIH.
  36. 36.
    Bethea TN, Kitahara CM, Sonderman J, Patel AV, Harvey C, Knutsen SF, Park Y, Park SY, Fraser GE, Jacobs EJ, Purdue MP, Stolzenberg-Solomon RZ, Gillanders EM, Blot WJ, Palmer JR, Kolonel LN (2014) A pooled analysis of body mass index and pancreatic cancer mortality in African Americans. Cancer Epidemiol Biomark Prev 23(10):2119–2125. doi: 10.1158/1055-9965.EPI-14-0422 CrossRefGoogle Scholar
  37. 37.
    Clarke T. Jo Biden Announces Next Steps in ‘Cancer Moonshot,’ ReutersGoogle Scholar
  38. 38.
    eMarketer (2013) Smartphone, tablet uptake still climbing in the US: Hispanic smartphone mobile device use exceeds averages.
  39. 39.
    Pew Research Center (2013a) Mobile technology fact sheet. Pew research internet project.
  40. 40.
    Pew Research Center (2014a) Internet project: mobile technology fact sheet.
  41. 41.
    Pew Research Center (2014b) Internet project: social networking fact sheet.
  42. 42.
    Pew Research Center (2013b) The demographics of social media users-2012.
  43. 43.
    Pew Research Center (2015) Social media update 2014.
  44. 44.
    Nielsen (2014) Digital es universal: how US Hispanics are driving growth in digital.
  45. 45.
    Centers for Disease Control and Prevention – CDC (2011) Building our understanding: culture insights communicating with Hispanic/Latinos. Creating a culture of health leaving.
  46. 46.
    Sensis (2010) Hispanic youth advertising.
  47. 47.
    Liedtke JA (1995) Changing the organizational culture of technology education to attract minorities and women. Technol Teach 54:9Google Scholar
  48. 48.
    Education. (n.d.). Accessed 1 Apr 2017
  49. 49.
    The Irving Institute for Clinical and Translational Science. (n.d.). Retrieved Apr 2017
  50. 50.
    Medicine VU (n.d.). Center for Precision Medicine. Retrieved Apr 2017
  51. 51.
    Precision Medicine Doctoral Training Programme. (2017, March 27). Accessed 1 Apr 2017
  52. 52.
    Smydo J (2015) No one left behind: technology can be used to cut health care disparities. Pittsburgh Post-Gazette.
  53. 53.
    Ayanian J (2015) The costs of racial disparities in health care. Harv Bus Rev. Accessed 1 Oct 2015

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Cancer Therapy & Research Center, Institute for Health Promotion ResearchUT Health San AntonioSan AntonioUSA
  2. 2.Cancer Therapy & Research CenterUT Health San AntonioSan AntonioUSA

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