Chasing Cancer: Combatting Disparities from the Frontlines
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This Washington Post Live Chasing Cancer podcast is sponsored by Pfizer Oncology, fighting for eight cancer breakthroughs by 2030. I'm Kwari Alin with the Washington Post, and welcome to Washington Post Live. Thanks for joining us for another installment in our Chasing Cancer series.

My colleague Frances Steed Sellers had the opportunity to learn more about where the fight against cancer stands from two women on the front lines. She spoke with Dr. Shanna Natiri about the important work of the Baltimore City Cancer Program, where she's the medical director. Frances was then joined by researcher Kimberly Enard, where we learned about the many factors that drive racial disparities in cancer care and their outcomes.

Given that certain groups have higher rates of poverty, have higher rates of living in neighborhoods that may not have the same type of green space, access to care, those types of things, you'll see those things contributing to either lack of detection and also in some cases, less availability to be able to engage in lifestyle changes that might help to prevent certain types of cancers. Well, I think it's three years since we last spoke and I'd love to just

reintroduce our listeners to the Baltimore City Cancer Program. Tell us a little bit more about how it started, what your role is and what you do.

Sure, I'd love to do that. So the Baltimore City Cancer Program was started in 2001. So getting ready in this August to celebrate anniversary number 24. So almost getting to 25, which will be a big celebration. But the program is a community-based initiative of the University of Maryland Green and Bomb Comprehensive Cancer Center.

and it is funded through the Maryland Department of Health through the Cigarette Restitution Fund. And we have the charge of bringing cancer control services to residents of Baltimore and the communities immediately surrounding Baltimore.

We focus on breast, cervical, and colorectal cancers and really want to make sure that we provide access to the residents of Baltimore City who may not otherwise have access because they don't have insurance or they have an insurance program that has a copay or deductible that is too high.

Through that, we work through a phenomenal staff. I say we are unique because it is a staff all of women. Phenomenal women is how I like to refer to us. But they provide services extending from outreach and engagement, so thinking about education at health fairs and those types of things, all the way through survivorship. So it really is a wonderful program. And I have the honor and privilege of serving as the medical director for the Baltimore City Cancer Program.

What an important job. And I know that one focus of the whole program is screening. Can you talk to me a little bit about the importance of early screening and how you can go about it in the communities you're managing?

Absolutely. I think early detection or cancer screening is essential, right? As a family physician, I really place emphasis on prevention if you can. And so what screening does, it enables us to find cancers if they are present early on, where treatment has, we have broader treatment options, where the likelihood of survivorship after diagnosis is greater, where the likelihood of an improved quality of life is greater. And so, you know,

Like I said, with the Baltimore City Cancer Program, we focus upon breast, cervical, and colorectal cancer screening. So that's using things such as mammograms, pap smears, colonoscopies. We are excited in the upcoming year, we'll also be introducing Cologuard, which is a home-based screening test. So we're really, when we talk about access, that's going to improve access. But there are other cancers that we don't,

with including lung cancer, prostate cancer that also can be screened for. But we know without a doubt screening saves lives because we're able to find cancers early on. So really important.

Within the Baltimore City Cancer Program, I think what is essential is developing relationships, right? Going into the community, making sure that people know, number one, what is screening? How does it work and why is it important? And then letting people know that you have access through us. We have staff members who will be happy to walk you through the entire process, answer questions, help you with scheduling, do things like arrange transportation so that you can get to your screening appointments. And

do any follow-up that is needed after screening. Because we also say the screening kind of, it doesn't end with screening, right? Even if you have a normal screen, we want to make sure you come back in the recommended interval. And if you have an abnormality, it's really important that you do that diagnostic workup in a timely manner.

Oh, that brings me to a very important question, though, about screening, because there can be false positives, right? Talk to me about that potential and whether that now technology is allowing us to move ahead and to put that a little bit behind us or not.

Sure. I think false positives, it's an important thing. I think, you know, even before I answer that question, I'll step back and say that when you think about this cancers that we have screening for versus the cancers we don't have screening for, because people will ask, how come there isn't pancreatic cancer screening? And part of the reason for that is that we want to make sure that when we're doing screening, the risk versus benefit. So the possibility of having a false positive is relatively low.

With that, anytime cancer screening is taking place, there should be a conversation between the individual who is doing the screening and the person who is referring them for screening about the risk and the benefits. So we refer to this as shared decision making, really so people understand when you go in, there is a possibility of a false positive. If this happens, this is the next steps. These are the next steps in care. And we'll walk you through that.

So a common conversation that one might have with a family physician is a woman who's going for the first mammogram. If you're going to get your first mammogram, there's no film to compare it to. And so if we find anything, the likelihood of recall is greater. But once you've got kind of a library of films, if you will, that we can refer to and compare to, it makes the likelihood of a false positive less, which speaks to the importance of not only screening once, but coming back for screening time and time again.

So you get this pattern of repeat films, of repeat screenings. But tell me, describe to me some of the specific problems or barriers to accessing screenings that occur within marginalised or minority populations.

Sure. I think some of the screening barriers that occur are the barriers that occur in all populations, right? If you look to the literature, you see one of the major barriers is time, right? And I think there are very few of us who can say, "I've never missed a doctor's appointment or a dentist appointment or a lab because of lack of time, right? It just didn't fit in with my life schedule, and so I needed to get in with that." So that's the number one thing is making sure that people have the ability to make time within their schedules to do these things.

I think when you talk about specific patient populations, though, there are additional barriers. There are concerns around trust.

Do people have a relationship with a primary care provider or another part of the healthcare team that they really feel like they can ask those questions that they may have around screening? And when they ask those questions, they get responses that make them feel like I'm safe, I'm in an okay space. One of the major barriers that the Baltimore City Cancer Program aims to deal with or overcome for individuals is not having health insurance.

The cost of these screenings is not astronomical per se, but a couple hundred dollars is pretty significant. And so we want to make sure that not having insurance doesn't stop people from getting screenings. And importantly, again, if they have an abnormal and you have to do that diagnostic workup where costs can certainly go up, that that's not a barrier as well.

Health literacy is another thing that we talk about. Do people understand why and when these screenings need to take place, that they need to take place on a regular basis? Sometimes the thought is, well, everybody knows that you need to get a mammogram or when you need to get a mammogram or when you need to get a pap smear. And that's not true. I do a lot of work going out into the community to give lectures and presentations. And I keep it kind of simple. I say, you know, the five W's.

who, what, where, when, and why, just making sure that people have that information and so that they can transmit it onto others. - That's what we learn as reporters, who, what, where, when, and why. - That's right, we all learned that in elementary school. - You've obviously worked very hard on building trust, but when you think about maybe the two top things that you've learned at Baltimore City and your community centers that you could convey to other centers, what would they be?

Sure. I think one of the big things would be that trust takes time. Building trust takes time. Oftentimes, as healthcare providers, right, we're ready to go. We're like, we have this great idea. We have this tool. We know that screening works and we want folks to have access to it and tap into it. And so we jump in and we're ready to go, but people are not necessarily there depending on competing priorities in their lives and other things. And so you have to be willing to build trust over time.

over time. Some people will, you know, they talk about early adopters and late adopters. When it comes to technology, I always say I'm a bit of a later adopter. I want to hear about it. I want to understand it, ask questions before I jump in. And it's the same with healthcare. I think the other key component is making sure that the communities that you want to work with, you have trust because you have members of those communities who are doing the work. So we couldn't do the work of the Baltimore City Cancer Program. We could not

be as successful with the Baltimore City Cancer Program without the phenomenal staff that we have, many of whom are members of the communities that we're making sure we want to have access to. So people have familiar faces. When you have a person, you're like, oh, I remember seeing this person before. Or a friend is telling you, I know this person. It makes it easier to come in. So I think the two things for other programs that are thinking about how do we do this is give yourself time and have patience.

and make sure that you have those gatekeepers or those trusted individuals that can help you learn the needs and the priorities of the communities that you want to work with. - You know, one of the phrases I've heard is trusted messenger. And it seems to me you're describing exactly that. It's a phrase that came up a lot during the COVID-19 pandemic. Have you seen trust increase or drop since then? Can you draw any broad conclusions about the impact of the pandemic?

That's an interesting question. I mean, I think I can say yes and no. I think, you know, around the COVID pandemic, people still have questions, right? There is still some concern about vaccine and how things happened and how things were developed. So those things are there. I think also because of the COVID pandemic, it opened up the opportunity for conversations, right? The healthcare community, healthcare teams,

really got a lot of education on the importance of being a trusted messenger. And again, on how do you communicate with patients and communities on this matter that we know is so important, is so effective. We may have trust in it. We may believe in it, but individuals and communities do not.

And so how do you use that knowledge to kind of navigate and negotiate with individuals that you want to be accepting of this information? And I think it does go back again to needing to have patience. I can tell you within COVID, you know, I had some patients who right away, they were like, doc, where do I sign up? How do I go? Where do I, how do I get this?

And I still have patients to this day who've told me they haven't gotten the vaccine. They don't plan to have the vaccine, but I continue to have conversations. I say, that's fine. I respect where you're from. At this point, everyone has a lot of information, right? We're far beyond. So people probably have the information they need to make a decision. But I continue to revisit the issue to say, if you ever change in terms of your perspective, I'm here. I'm happy to help. And so I think in that sense, we have had that learning, at least on the healthcare professional side.

Dr. Ntieri, I mean, there are very good reasons for mistrust, right, particularly with Black communities. And we can think of many examples, some right in Baltimore, like the Henrietta Lacks example at Hopkins. Absolutely. How do you address, I mean, these are real concerns. It's not as if mistrust comes from ignorance. It comes from knowledge in many ways.

Yeah, a lot of the time this mistrust is generational, right? I can think of a patient that I saw yesterday was having a conversation with her about cervical cancer screening. She's from Baltimore and the Henrietta Lacks conversation came up. And I think acknowledging the reality of those conversations, particularly for a woman who's telling me the advice that she had gotten from her grandmother, I have to acknowledge that. I cannot say you're incorrect.

I have to acknowledge it. We had a conversation. Conversations, again, you need time to work through that. And I said, let's talk through our next steps. So I think being aware, I will tell you that in my medical education, I didn't learn about Henrietta Lacks. Coming to Baltimore, I had to learn. I had to read. I had to understand. I had to understand the dynamics of mistrust in Baltimore because they do tend to be unique to communities.

Once you're aware, you can ask questions. And sometimes things will come up around mistrust that I'm not aware of. I don't understand. And that's the opportunity for me to become the learner and my patient to become the teacher or the community member to become my teacher. And I sit and I'm quiet and I learn.

And we should just maybe remind the audience that Henrietta Lacks was a cancer patient whose cells were used without her knowledge and went on to produce treatments for other people, many of them without her racial background. This issue of trust is so important. We now have other phenomena coming up like increases in numbers of diagnosis of cancer among young people. Are you seeing that disproportionately affect minority populations or just young people across the spectrum?

Well, I think it's a bit of both, right? If we look at differences in cancer diagnosis, we know, for example, that African Americans or Black individuals compared to white individuals, even if we don't have a higher rate of diagnosis, we have a higher rate of mortality. So those things exist.

If you then add on that people are also being diagnosed at an earlier age, that means for an individual who is both younger and Black, the likelihood of being diagnosed earlier is going to be compounded. And so we see some of those things for sure. I think part of this is we have better screening tests, we have better knowledge.

But certainly there is concern around this. You'll also see changes in the recommendations or the guidelines for when to initiate cancer screening or when to stop that are based upon the newer information that we have.

We've had a lot of questions from the audience about potential impact of the cuts of NIH and funding for research. And I wonder how that affects a group like yours. You're within the University of Maryland in one part of your job and then out in the Baltimore Cancer Program. How do you see this affecting research going ahead and particularly the impact on minority communities?

Sure. Well, we know, I feel that, you know, research is key to advances that we see within cancer. I think if you look at cancer outcomes from even 20 years ago to today, they've advanced significantly and research is the reason for that. So certainly within these communities, there are a lot of conversations about how we continue to do the work that we know is important, how to do the work that we know is impactful.

I had a conversation with someone and I said, you know, one of the beautiful things about research is that beginning of the word is re, right? You have to reimagine, you have to reinvent, you have to redo in order to continue the work. And I think that's the challenge that the research community is faced with right now. How do we continue on to do work that we feel is impactful, to do work that we feel is important,

within the current context. And there are lots of wonderful conversations going on. People are re-energized talking about another re in terms of we've got to make sure that this work continues. When you think about populations of color, they also are going to be impacted with these changes in part because we know that there are gaps when you look at certain populations in terms of cancer outcomes and the work that we're doing and that work that is ongoing helps to decrease those gaps.

But we'll continue to do the work that we do. Thankfully, with the Baltimore City Cancer Program, we haven't been directly impacted, but we know at any time things could change. But listen, the good work's got to be done. And so we'll keep pushing forward. Well, tell me, we have to wrap up soon, but I have a sort of big question for you. And that's about your optimism. What sets you on fire and makes you so committed to go ahead when you're struggling against, you know, some forces, pretty big forces?

Yeah, you know, what keeps me optimistic, I think, is the individuals that I have an opportunity to work with. I have wonderful colleagues both here in family medicine within my department across the nation who are family physicians who are committed to good work. I've got, as already mentioned, the wonderful colleagues that I have within the Baltimore City Cancer Program and within the cancer center that I work with in the larger cancer community. And I think, you know, you get

recharged when you work with these individuals and refocused about the importance. And then I would say as a physician too, it's the direct care that I have with patients. Patients constantly remind you of the importance of the work that you do. When you have conversations and they say thank you and they remind you of the impact that you've had in your life, it makes you continue on and continue to push to do the work.

Well, we want to see you continue on. I'm sorry we don't have time to continue on right now in this conversation, but Dr. Natera, it was fabulous to hear from you. Thank you so much for joining us. Thank you for having me, Frances. Take care of yourself. Thank you. And I'll be back soon with my next guest. Stay with us. Welcome. My name is Tina Duggan, and I'm the commercial president of Pfizer Oncology.

I'm pleased to speak today with Dr. Wayne Frederick, Interim CEO of the American Cancer Society and the American Cancer Society Cancer Action Network. We're discussing a subject that is a top priority for both of our organizations, and that is health equity. Advances in science and technology have put us on the cusp of a new era. And at Pfizer, we're accelerating our efforts with over 40% of our R&D investment focus in oncology.

But unfortunately, the incredible progress the oncology community has made is not benefiting everyone equally. The American Cancer Society shares in our vision that everyone impacted by cancer, no matter who they are or where they live, should receive quality care. So thank you, Dr. Frederick, for being here today. Thanks for having me. So let's start by better understanding the challenges.

Can you tell us a bit more about the disparities that exist in cancer care? Well, unfortunately, there are some disparities that exist that have been persistent for quite some time. And unfortunately, in our most recent cancer report from January of 2025,

we see some new emerging challenges as well. So for instance, black women are twice as likely to be diagnosed with breast cancer at the latest stage than white women and are 40% more likely to die from this disease, despite the fact that they are less likely to actually get a breast cancer than white women. So that's a persistent problem that we're seeing continues and we're not able to close a gap thus far.

Black men are also at higher risk for prostate cancer, yet they are less likely to be screened and more likely to be diagnosed at an advanced stage than other racial and

ethnic groups. So that again is a major concern here. And as a result, they are two times more likely to die from this disease as well. So we're certainly concerned there as well. 20% of rural Americans live more than 60 miles from an oncologist. So that access to care for rural Americans is certainly a major challenge and one that we certainly continue to be very concerned about.

Later cancer diagnosis is obviously tied to poor outcomes and that leads to significant health disparities. So if people aren't being screened in a timely fashion or even when they're screened, if they get a diagnosis but can't access that care for one reason or another, such as not having transportation,

They may have health literacy challenges, not having patient navigation, or some cultural barriers may exist as well. So these are some ongoing persistent disparities. And as I said, some emerging ones that we see and that we're continuing to try to work on so that we can move those barriers away from people surviving, or for that matter, even being diagnosed with a cancer.

Thank you for that, Dr. Frederick. You know, clinical research is another area where we at Pfizer see significant disparities. Some studies estimate that as few as 4 to 6 percent of cancer clinical trial participants are black and only 3 to 6 percent are Hispanic. And in addition, about half of cancer patients in the United States are treated in community practices. Yet this is not typically where clinical trials are taking place.

So at Pfizer, we're working hard to ensure diverse representation in our clinical trials, which is critical, by providing access to information, earning the trust through advocacy partnerships that educate and correct misinformation about trials. And we have a dedicated diversity and clinical trials center of excellence, helping us to select investigators and trial sites in the highly impacted communities, which we believe is critically important.

But increasing awareness of and access to clinical trial opportunities is also a focus of the Change the Odds initiative. Can you tell us more about the Change the Odds and share some of the achievements today?

Yeah, most certainly. This is a very, very important program for us. And we're very thankful that Pfizer has certainly supported this and has collaborated with us. Change the Arts is designed to bridge the gap in cancer care disparities by enhancing awareness of and access to cancer screenings.

clinical trial opportunities as you just outlined, and patient support and comprehensive navigation. These three pillars we think are absolutely necessary for us to close the disparity issue that we highlighted earlier. Our goal is to reach people where they are with services and link them to appropriate follow-up and support. Oftentimes, people just don't have the resources to even know where they can go to access, for instance, low-cost or low-cost screening as an example.

So Change the Odds has helped us reach over 16 million patients to date, engaging about 2,900 partner organizations and distributing over 51,000 resources. So in year one of the program, 406,000 new users of the screening and risk reduction sites participated and over 88,000 new users of medical content came to cancer.org, our website.

That's pretty incredible. And as you said, this is just year one. And another highlight has been the launch of the American Cancer Society's Cancer Risk 360 tool, which helps people better understand and mitigate their cancer risk factors. It's a pretty amazing tool, and we're very proud to feature it on our Pfizer for All digital platform.

And following that launch in February, nearly 12,000 people completed the questionnaire to understand their risk factors. So that's a really important progress also. So these early metrics, they speak to the direct impact of our collaboration. And we're certainly honored to be named the American Cancer Society's 2024 Corporate Partner of the Year. But looking ahead, how can we continue to build on this momentum and make an even bigger impact?

Well, certainly I think we have to continue to try to reach more patients. So getting the word out, driving more traffic to our websites and getting more people to understand their risk factors using the Cancer360 tool as an example, visiting cancer.org slash change the odds for screening and other resources is extremely critical. I also think that our shared values

of Pfizer Oncology and the American Cancer Society have led to such a strong collaboration. Both organizations are very focused on making the patient an obsession of our affection, as it were. And I think getting those resources to underserved communities is the key for us to continue to expand and build on the momentum.

Well, thank you, Dr. Frederick, for joining me today in such an important discussion. It's clear that no one individual or organization alone can tackle the substantial disparities that exist in cancer care. It will take partnership across the entire healthcare ecosystem at every touchpoint along the patient journey to make a real difference.

And I certainly look forward to our continued collaboration as we advance towards a more equitable future for cancer care. Now I'm delighted to welcome Dr. Kimberly Enard. She comes to us as an associate professor from St. Louis University College for Public Health and Social Justice. Dr. Kimberly Enard, a very well welcome to Washington Post Live. Thank you so much for having me. I'm delighted to be here.

Well, we're delighted to have you. And I would love to start by talking a little bit about progress and how it isn't experienced equally. So take breast cancer. I think there's been a 10% drop in deaths from breast cancer over the past decade. But that drop isn't experienced by black women the same way as by white women. Can you talk to me a little bit about the extraordinary gap in that experience for black and white women and what might be behind it?

Sure. So certainly we've seen a lot of progress over time in terms of the early prevention, detection, and treatment of breast cancers, which has really set people up for living longer, being able to survive these diseases. However, we continue to see an exacerbation of disparities among Black women compared to white women and other groups.

despite all of this progress. And a lot of that is because or attributed to disparities, including that are built upon socioeconomic differences, environmental and other disadvantages that sort of influence the way that different groups access or experience or receive health care. And these types of things occur across the life course.

So, for example, a woman who is in a certain type of neighborhood has been exposed to different type of environmental factors, may not have the same access to health care and to health insurance coverage as other women. They are at a disadvantage. And so as we see progress,

In certain groups, you'll see that gap increase because of some of those other factors that are influencing health outcomes. So as I listen to you, I hear two things. I hear you talking about access to care, but could some of those factors also be causing the cancers in the first place when you talk about environment, for example?

Certainly there is some research and evidence that shows exposure to certain environmental aspects can contribute to certain types of disparities among these populations.

Also biological factors related to ancestry. So some of these factors are inherited generics and our body's immune responses, but also contaminants in the air and water and food we consume and places where we live and work. And so given that certain groups are

have higher rates of poverty, have higher rates of living in neighborhoods that may not have the same type of green space, access to care. Those types of things you'll see, those things contributing to either lack of detection and also in some cases, the less availability to be able to access

engage in lifestyle changes that might help to prevent certain types of cancers. You are painting a fascinating and also very complex picture about the causes of the cancers and then access to care. And it seems to me it goes way beyond doctors. And that brings me to an audience question that came in. The question comes from, let's see, Jesse Fields in New York.

And Mr. Field says, how do we as doctors and healthcare professionals address and change social conditions that impact on health? What a great question.

Absolutely. It's a fabulous question. And that's one of the things that I've been really interested in, in the work that I do. We, when patients go to, to visit doctors to for their healthcare, preventive healthcare for treatment, doctors are very pressed for time in those interactions. They have a very short period of time to, to talk to the patient, find out what's going on, make their recommendations. And, and it,

And in that time period, sometimes they may not have time to get to know what is the social environment? What is the environmental area that this patient lives in? And if we're going to have a conversation about how to prevent cancer or about how to

engage in lifestyle changes, how do you really understand if you come to an agreement about what the best course of action is if there's not enough time in those interactions to be able to really understand that? So it's kind of the interaction between

between shared decision making and social determinants of health. And so in a lot of cases, um, you know, we have seen some progress because now the, the medical, the electronic health weather record has a space for, um, information about social determinants. A lot of healthcare organizations are gathering more and more information and, and documenting that, but then comes to the question, what do you do with that? How can they address those issues? And so, um,

What we're seeing more and more is health systems partnering with community-based organizations, working with internal or external patient navigators or community health workers in partnership to kind of get to those issues and really try to help people navigate things that are outside of the medical realm.

So again, we've got this very complex picture of how we can account for racial disparities. But there are terms that come up that really refer to the way the health system is constructed, including structural racism. What does that mean in your view in terms of how the health system works and reaches people in need?

or not? Well, I think that's a very, um, that's a very complex question. There's certainly, um, historical, um, there's a lot of history behind how those things came to be. Um, for example, where, um, health systems and doctors and certain types of healthcare are located, um, people living in areas where it's harder for them to get to, um,

the types of health care that they need. And those things have kind of been built in the system. When organizations decide how to operate, they make decisions about where they want to locate based on some type of business model. And a lot of times that is not going to be something that benefits people of color and certainly not people of low social equity.

economic background and even rural populations. Some of these things are sort of baked into the cake to set things up for them not to be able to have access. But on top of that, there's, you know, we know over time that there's been a lot of, you know, bias and uncertainty and mistrust within the healthcare interaction.

For patients and physicians and the frontline providers to be able to navigate that, we haven't, we're starting to give more attention to how we train people to be able to understand how to have conversations with people who are not like them.

Um, but there's still a lot of work to do. Um, I think a lot of that gets at sort of the structural mechanisms that, um, really put disadvantaged certain populations, um, compared to others. And then also just the way we finance, um, healthcare in this country. Um, we have private insurance, which is largely, um,

employer-based insurance. That's what you and I probably have, but others don't have access to that type of insurance. And maybe they're on some type of public insurance, Medicaid or Medicare, which has different rules. And then some people may not have any health insurance at all. So all of those things are kind of structural mechanisms that can lead to disadvantages when it comes to accessing healthcare.

That seems like such common sense, and yet how do you measure it? You're from an evidence-based culture. How do you measure the impact of structural racism? Well, that's a good question. I think that I'm sorry that I don't think I'm going to be able to really fully answer that question. I think a lot of researchers have looked into evidence

measures of racism and perceived racism. And it is definitely, you know, I've even done a study where you looked at how people felt about how they were treated in different healthcare settings. And so we can measure sort of how people experience it.

And then we can look at that and make some, you know, try to draw some conclusions about how that has influenced our health outcomes. But it is something that's very difficult to really quantify. And that's an area where we really do need more research to really understand how do you get from this cause to that outcome? And then what can we do to fix it?

And talking of research, minorities are way underrepresented in clinical trials, right? And what's the impact of that and what is being done to bring in a wider diversity of people to take part in trials?

Yeah, so it's a historical disadvantage for a lot of groups. So we definitely have been underrepresented in clinical trials. We've been underrepresented in the data that people are using to develop new therapies and technologies. And that does put

us, you know, people of color at a disadvantage in terms of being able to benefit from these treatments. So there's lack of diversity in existing cancer genomics data sets. There's underrepresentation of minority groups in clinical trials. There's not enough diversity in the research workforce and all of those things kind of come together.

to create a situation where some groups benefit more from medical advances than others. When these therapies are being developed, a lot of times they're being developed based on data that is largely white, largely male,

and don't work necessarily the same in other populations. And so we need more research. We need more inclusion of people in our research projects in order to be able to get at that

precision to have more precise ways of developing therapies and prescribing therapies. I mean, it makes sense that we're not all the same, even within the African-American population, for example, there are a lot of differences. So we need to have more data, larger sample sizes of people who are, you know, of diverse groups so that we can really drill down and better understand what

would work better in one population versus another. In research, we look at interactions and we want to understand how a person might have one characteristics based on

you know, their genes and their physiology combined with their environment that makes them more or less susceptible to disease. And in order to find these answers, the answers to these questions, we need to engage diverse populations and research in a way that feels authentic to them and safe.

and practical based on their lived experience. Your previous guest talked about how working with communities, they were able to do the work that they do. And I think that is a really key ingredient in a lot of the work that needs to be done to really improve how we're looking at these things and delivering care. We need to

We've got all these local experts in communities across the country, and we need to bring them into the conversation early, let them help us make decisions about how we're doing things, and that will help us to build trust and actually do more meaningful work. And of course, it helps to have figureheads both in the research community, researchers of color, of course, and I'm guessing you would say doctors, medical practitioners of color.

What impact can that have? And let's go back to cancer as well, in particular, on bringing people in, on developing trust, on developing these kinds of trusted messengers we were talking about in the last conversation.

I think it's really about lived people seeing themselves in the people that they're having conversations with, the lived experience, being able to understand what a person is going through beyond their disease. A person is not their disease. They have a whole life. They have a whole set of

issues that that help them or hurt them in their lives. And being able to have a conversation with someone, a lot of times someone that looks like them. But there are other ways that people connect that goes beyond race. And I think that

And you know, you've seen in some research that there is having that concordance between the provider and the patient really helps facilitate a better conversation. You get a little bit further, you get more information about what they're really dealing with, and then you can actually get to the root of what they need to support them to be well.

And of course, one thing we all need is health insurance. You mentioned earlier on the sort of the gaps in health insurance. How does that really feed into how people access screening, diagnosis of cancer and then care of cancer? Well, absolutely. I mean, that is one of the reasons that the Affordable Care Act was implemented, giving people access to

health insurance coverage, the idea that it would give them better access to health care. And it's an enabling factor. It's something that enables people to be able to go to the doctor, to get certain types of screenings without having to worry about cost upfront.

When people go, you know, the insurance is a mechanism to access care, you can kind of figure out, okay, well, if I need to go in for screening, then I know that this is 100% covered, I'm not going to have

any costs out of pocket. So that's not a barrier. There may be other barriers like being able to find time to do it and getting out of work and getting to the location. But in that case, if you know that you have that coverage, then cost is not a barrier. For people who don't have a certain type of insurance,

that would cover those screenings, they're gonna be thinking about, do I pay for groceries this month or do I go get this breast cancer screening? So those are all important decisions that people have to make. They have to balance all of the things in their life to be able to figure out what they can do. Insurance is a key that helps people be able to access care at a cost that they can estimate.

And, you know, we're on the cusp of this sort of revolution in terms of AI, personalized medicine, precision medicine, other technologies that could be levelers or could exacerbate disparities. Where do you see this going? Or maybe it's a mixed picture, but I'm just fascinated by

looking ahead and thinking what these Technologies could mean for again cancer treatment diagnosis and treatment absolutely I think it's really exciting um and I agree with you um is it going to make things better or worse and I would say yeah there's a potential for both

So AI is being used in a lot of situations to help people access, you know, to fill out applications for social programs like WIC or Medicaid and things like that. It's helping people get to the right place.

without having to talk to a number of different people. There's a lot of potential for AI to just really improve the experience, but AI is artificial. And so it's not a real person and not everybody's going to be able to interact with it in the same way. And so there could also potentially be

be a pathway for people to having some of the disparities exacerbated from that. And then on top of that, I would just say that AI is machine learning. It needs data to make suggestions. It needs data. And so if there's already bias in the data set,

AI can compound the bias that's already in that data set. And so it's really important for all of us to be mindful of both the opportunities and the challenges of AI. Dr. Enad, we have to wrap, but I have one last question that I can't resist asking. You started your career as a journalist. Clearly, communications are very important to you. Tell me about this journey from journalism to where you stand now as an associate professor. So I...

was a at the time that I started as a general reporter in a small market in Macon, Georgia. My mother was had been diagnosed with Alzheimer's disease and I was her primary caregiver. And at the time, I didn't know the difference between Medicare and Medicaid. And I had to learn really quickly because I was trying to work full time. You know how hard it is to balance being a reporter with life in general.

And because I was doing a lot of work around that, my news director said, you know what, you'd be a great health reporter. So I switched over there and did learn very quickly the difference between Medicare and Medicaid and a lot of other things. But one of the things that really bothered me was sometimes I would talk with people. I got to talk with people, everyone from patients all the way up through doctors.

lawmakers and administrators at different hospitals and patients would call and say, you did this report on this new therapy that I think would help me, but my doctor says I can't have it because I don't have health insurance. And I didn't, you know, I'm still learning at the time as well, but it really

you know, resonated with me and I wanted to learn more about the health system and how I might be able to, to be part of a solution. And so I went and, um, um,

went through school to learn how to be an administrator and worked on that side of the industry for a while and then decided that I wanted to even go a little bit further and understand better how to measure all of these interventions that we were doing.

It really started out as a personal journey and it still is. I still get a lot of my inspiration from family members and friends who are having interactions that are less than optimal. I think that's where a lot of the best questions come from. But yeah, it's been quite a journey.

Well, we are delighted you took that journey and hang on to those old skills of communication in addition to your research skills. Dr. Enard, thank you so much for joining us today. That was fascinating. Thank you so much for having me. Thanks for listening. For more conversations like these, be sure to follow our Washington Post Live podcast page on Spotify and stay tuned every Friday for our weekly episodes. I'm Kwari Alin, signing off for Washington Post Live.

We interrupt this program to bring you an important Wayfair message.

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