Today's universal improvement in melanoma survival is encouraging. But the reality is racial disparities aren’t going away and in some cases are getting worse.
Racial disparities in melanoma survival continue among U.S. minorities despite availability of immunotherapy and targeted treatment options that have helped improve melanoma outcomes universally, according to a study recently published in the Journal of the American Academy of Dermatology (JAAD).
Minorities have long suffered worse melanoma specific survival rates than whites, who are the majority of cutaneous melanoma patients. But population studies examining racial disparities in the care of U.S. patients were largely based on registries from the 1990s to 2000s. It was unclear if the disparities worsened, improved or remained stable since the introduction of immunotherapy around 2010 and after, according to the authors.
Researchers at NYU Langone Health in New York City studied more recent data, reporting on more than 381,000 patients from the Surveillance, Epidemiology and End Results (SEER) registry. They analyzed the association between melanoma specific survival and race before 2000, between 2000 and 2009, and in 2010 and beyond. Categories included non-Hispanic whites, as the reference group, Hispanics, non-Hispanic Blacks, non-Hispanic Asian or Pacific Islanders, and non-Hispanic American Indian/Alaska Natives.
They found disparities persist. In some cases, disparities became worse with time.
Hispanics, Blacks and Asians and Pacific Islanders suffered worse disparities in melanoma survival from before 2000 to 2010 and after.
People with localized disease in all U.S. minority groups experienced increasing disparities.
Melanoma survival for Hispanics with regional and distant disease worsened compared to whites, but that was not the case for other minorities with regional and distant disease.
While melanoma survival improved from before 2000 to 2010 and after, the improvement was most pronounced for white patients and was not significant for Hispanic and American Indian/Alaska Native patients. For example, 5-year melanoma specific survival was 88.1% for whites diagnosed with the cancer before 2000 compared to 92.9% for white patients diagnosed post 2010. Melanoma specific survival was 85.4% for Hispanics in the earlier time period compared to 86.5% after 2010.
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Reasons for health disparities in melanoma care include challenges to detecting the disease early in minority patients because of biologic, socioeconomic and cultural factors. Racial and ethnic minorities are less likely to have health insurance coverage than white people in the U.S. And minorities are underrepresented in melanoma clinical trials, according to the authors.
“Given ongoing demographic changes in the U.S., it is imperative that clinicians recognize the barriers to primary, secondary, and tertiary prevention of melanoma for minority patients. The ability to do so requires a thorough understanding of how presenting features and outcomes vary according to race and ethnicity,” the authors write.
Stats according to race, ethnicity
SEER data revealed more than 95% of melanoma patients were white and more than 57% of white patients were male, whereas more than half of Black and Hispanic patients were female.
Black patients were more likely than the other groups to have acral lentiginous melanoma. And a higher percentage of minorities had mucosal melanoma compared to white patients.
Lower limbs or hips were the most common primary sites for melanoma among Hispanics, Asian or Pacific Islanders and Blacks. Whites developed melanoma more often on the trunk or upper limb and shoulder.
Minorities groups had a higher percentage of mucosal melanoma than whites.
Minorities presented with later disease stages than whites. Among whites, 12.6% presented with regional or distant disease, compared with 21% of Hispanics, 34.1% of Blacks, 28.6% of Asians and Pacific Islanders and 18.6% of American Indian/Alaska Natives.
Whites had the lowest average tumor thickness and percent with ulcerated tumors.
Among the study’s limitations, SEER data doesn’t have immunotherapy or targeted therapy information. So, researchers couldn’t examine melanoma survival disparities among patients who received those treatments.
Still, today’s universal improvement in melanoma survival is encouraging. But the reality is racial disparities aren’t going away and in some cases are getting worse.
“Improving post-diagnosis management for minorities with localized disease is imperative to improve survival outcomes,” the authors wrote.
Qian Y, Johannet P, Sawyers A, Yu J, Osman I, Zhong J, The ongoing racial disparities in melanoma: an analysis of the Surveillance, Epidemiology, and End Results database (SEER) database (1975-2016), Journal of the American Academy of Dermatology (2020), doi: https:// doi.org/10.1016/j.jaad.2020.08.097