AACR Call to Action

Economic inequities, social injustices, and systemic barriers continue to adversely affect all facets of cancer research and patient care leading to a disproportionate burden of cancer for many US population groups. These disparities are driven by exposure to environmental carcinogens, limited access to health care and clinical trials, policies that exacerbate modifiable risk factors such as smoking and lack of access to healthy food, and impediments to the development of a research and health care workforce that is broadly representative of our society. Many programs and initiatives, both public and private, have been undertaken to address these challenges, but additional efforts and investments are urgently needed.

To make further progress in reducing cancer disparities, federal agencies and Congress must continue to play a central role in setting policies and making key investments to achieve health equity.

Because of the overlapping and intersecting causes of cancer disparities, concerted efforts in many areas of policy are needed, including:

Increasing federal funding for medical research and public health initiatives designed to reduce cancer disparities.
Increasing federal investments in STEMM education programs to create pathways for students from diverse backgrounds to be part of an inclusive research and health care workforce.
Improving the collection of disaggregated cancer-related data for all racial, ethnic, and sexual and gender minority groups.
Continuing efforts to ensure diverse representation in basic and translational research studies and oncology clinical trials, including support for community partnerships.
Expanding cancer prevention and screening efforts, such as addressing environmental exposures (including those related to the climate crisis), obesity, unhealthy diets, physical inactivity, tobacco use, and suboptimal uptake of vaccines.
Broadening access to equitable and affordable quality health care, including access to telehealth for underserved populations in rural areas.

To make further progress on all these fronts, AACR recommends the following actions:

1. Provide robust, sustained, and predictable funding increases for the US federal agencies and programs that are tasked with reducing cancer disparities.

Congress should appropriate at least $51.3 billion for NIH in fiscal year 2025 to continue progress in medical research and expand initiatives across NIH and the extramural research community to study health disparities and help achieve health equity.
Congress should provide higher appropriations for the National Institute on Minority Health and Health Disparities (NIMHD) to continue its pioneering scientific work on these issues and coordinate health disparities research across NIH.
Congress should appropriate at least $7.9 billion for NCI in fiscal year 2025—including funding for the NCI Center to Reduce Cancer Health Disparities (CRCHD), the NCI Community Oncology Research Program (NCORP), and other NCI and cross-NIH programs studying cancer disparities to expand research on cancer disparities, create an inclusive cancer workforce, and implement new prevention, screening, and health care access strategies.

2. Support data collection initiatives to reduce cancer disparities.

Data collection efforts through federal programs should include detailed demographic information, including sexual orientation and gender identity data to better elucidate the burden of cancer on specific populations, and the intersection of cancer burden with other health inequities.
NIH should fund large multi-ethnic prospective studies with biorepositories as resources for exploring current and future research questions related to cancer disparities.
NCI should expand cancer center partnerships to enhance collaboration with underserved communities, including with US Native populations, Native Hawaiians, and Alaska Natives.

3. Increase access and participation in clinical trials.

NCI should expand the NCI Connecting Underrepresented Populations to Clinical Trials (CUSP2CT) program to address lack of participation and diversity in cancer clinical trials.
FDA should fully implement the Clinical Trial Diversity and Modernization provisions of the Food and Drug Omnibus Reform Act (FDORA) of 2022, including requiring trial sponsors to utilize diversity action plans.
FDA should continue to work with the biopharmaceutical industry to expand participation in clinical trials, including through decentralized clinical trials and expansion of eligibility criteria when scientifically appropriate.

4. Prioritize cancer control initiatives and increase screening for early detection and prevention.

Congress should appropriate $472.4 million for the CDC Division of Cancer Prevention and Control and provide resources to enable CDC’s CORE Health Equity Science and Intervention Strategy.
Congress should robustly support EPA Cancer Moonshot Activities, including the Office of Environmental Justice and External Civil Rights (OEJECR).
Congress should provide increased funding for federal programs such as the Alcee Hastings Program for Advanced Cancer Screening in Underserved Communities, which aims to close disparity gaps in cancer screening by reaching individuals in geographically remote, rural, and underserved communities through community partnerships and patient navigators.
FDA should finalize the Tobacco Product Standard for Menthol in Cigarettes and the Tobacco Product Standard for Characterizing Flavors in Cigars, thereby banning menthol in cigarettes and characterizing flavors in cigars.

5. Implement policies to ensure equitable patient care.

States should expand Medicaid to improve health care access among lower income communities, reduce financial burdens on patients, and ensure coverage for necessary medical tests and follow-up care.
Through federal legislation or regulatory action, Congress and the federal government should ensure that Medicaid and private insurance comprehensively cover tobacco cessation services.
Congress should appropriate additional funds for HHS programs to expand and diversify the community health care workforce to guide patients with cancer from diagnosis through treatment and survivorship, improve patient satisfaction, and reduce disparities in cancer outcomes.
Congress should increase appropriations for the Indian Health Service, which provides critical health care services to millions of American Indian and Alaska Native individuals.

6. Reduce cancer disparities by building a more diverse and inclusive cancer research and care workforce.

NIH should continue the UNITE initiative in its efforts to address structural racism at NIH and in the broader medical research community.
Congress should fully fund the education and training programs of the CHIPS and Science Act to create more pathways for underrepresented groups to pursue STEMM careers.
NCI should continue key initiatives within the NCI CRCHD that support pathways into the cancer research workforce, including the following programs: Continuing Umbrella of Research Experiences (CURE), the Administrative Supplement to Promote Diversity, F32 National Research Service Awards and Fellowships, R21 Exploratory Grant Awards to Promote Workforce Diversity in Basic Cancer Research, R01 Cancer Moonshot Scholars, and the Transformative Educational Advancement and Mentoring (TEAM) Network.

7. Enact comprehensive legislation to eliminate health inequities.

We also strongly support recent Congressional efforts to enact comprehensive legislation to help eliminate systemic health inequities, such as the Health Equity and Accountability Act (HEAA), which addresses several crucial areas. Here are some of the priorities from the HEAA Act:

Expansion of Medicaid and the coverage of comprehensive tobacco cessation services.
Establishment of rural health programs, including a rural community hospital program to expand federal payments for healthcare services in rural areas.
Additional support to Historically Black Colleges and Universities and other Minority Serving Institutions to train a diverse and inclusive health care workforce.
Investments in health IT infrastructure for underserved communities.
New programs to address cancers that disproportionately affect minority communities and marginalized groups.

It is clear that while some progress has been made in reducing cancer disparities, there is much more work to be done to eliminate the health inequities. Fulfilling the aims of this Call to Action will require not only the commitment from the public sector, but also partnerships with many other stakeholders, including the biopharmaceutical industry, academic and medical institutions, patient-centric organizations, community-based organizations, and professional organizations, to achieve the vision health equity. These collaborations must be integrated with other efforts across our society to address the broader challenges of overcoming economic inequities, dismantling structural barriers, and rectifying social injustices to ensure the health and well-being of all patient populations.

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