Ask yourself ‘who is missing’

February 25, 2022

3 minute read


Disclosures: Roberson does not report any relevant financial information.

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Critical race theory originates in a legal framework, but has implications for the conduct of cancer research, according to Mya L. Roberson, PhD.

Robson, assistant professor in the department of health policy at Vanderbilt University School of Medicine, describe the historical and contemporary place of critical race theory in cancer research, including basic, clinical, translational and population health sciences in a commentary published in nature reviewthe cancer.

“It’s especially important to understand that cancer inequities start much earlier than when individuals are diagnosed with cancer,” Roberson told Healio. “Very often, inequalities are linked to where people live, the type of facilities they have access to and their environment.

“Understanding these broader contextual factors that impact the care individuals receive and their ability to adhere to various treatment regimens and receive high-quality care is critical,” Roberson added. “To change the current status quo of inequality, cancer researchers must globally ‘think upstream’.”

Roberson spoke with Healio about his paper, why it’s important to bring this information to light, and the need to rethink cancer research.

Helio: What prompted this article?

Roberson: I’m a social epidemiologist and cancer care delivery researcher, and I gave a talk in October at the University of Iowa Holden Comprehensive Cancer Center, where I basically laid out my theoretical framework for how I am thinking of cancer research as a whole and more specifically of my own work in cancer care. delivery and fairness. Fortunately, one of my professional peers attended this conference and encouraged me to write my theoretical framework. My colleague suggested that it might be useful for others to conceptualize why we see inequities in cancer at all levels.

Helio: What is the HeLa cell line and where does it come from?

Roberson: Henrietta Lacks was a poor black woman diagnosed with metastatic cervical cancer in the early 1950s. When she received treatment for her cervical cancer, her cells were removed without her consent and given to a researcher for use in his laboratory. The HeLa cell line became the first immortalized cell line and led to a number of discoveries both inside and outside of cancer, including the discovery of cervical cancer associated with HPV . The HeLa cell line has fundamentally changed medical science as a whole and specifically cancer research as we know it.

But Henrietta Lacks knew nothing about her cells taken during her treatment and neither did her family for many years after that. This immortalized cell line led to Nobel Prizes, commercialization and various scientific discoveries without proper attribution for a very long time to Henrietta Lacks herself and her family. It is sobering to think that what we know about cancer research has its roots in something we now deem unethical.

Helio: What must oncologists do for prevent it from happening again?

Roberson: The first step is to recognize that cancer research and biomedical research generally have an unsavory past, and we need to be open to talking about it. Fortunately, we have the proper policies and protocols in place to ensure that things like this Henrietta Lacks exploit never happen again. Oncologists need to understand that the processes contributing to cancer inequities begin long before patients even walk into their clinic. They must also understand the vast history of our field and how it has led to different outcomes between people of color and white individuals.

Helio: How can our readers rethink cancer research and what is specifically needed to develop clinical trials?

Roberson: One thing that can fundamentally change clinical trial research is thinking about inclusion from the start and not going all the way, and then realizing that the study didn’t attract people of color. This is a broad problem in cancer research and a problem in observational epidemiological and behavioral studies of cancer. Not enough attention has been paid to the people these trials and research represent. One of the things I’ve found particularly enlightening early in my career is engaging directly with patients, especially patients of color, because so many want to participate in research. Sometimes, as researchers, we can have biases about who wants to participate in research – beyond just enrolling them in clinical trials. It’s critical that patients of color provide input into the study design, involve them in the recruitment phase, and think about how best to reach them. We are experts in cancer research and cancer patients are experts in living with cancer. The whole cancer research enterprise could be strengthened by broader engagement of people with cancer. This will make clinical trials more inclusive and diverse, and will broaden the reach of different patient populations.

In a broad sense, my ultimate hope for this article is to challenge the way we think about cancer research. One of the most flattering things I can hear, especially from my fellow clinicians, is that they now pay more attention to people who are missing from their studies and the literature they read . If I could challenge readers to rethink one thing, it’s to ask you this question about your clinic, your research, and clinical guidelines: Who is missing from these? How do we include these people in our work, our clinics, and our care to ensure that we are not satisfied with the status quo and that we are moving the needle to support more equitable cancer outcomes in all populations?

For more information:

Mya L. Roberson, PhD, can be contacted at [email protected]

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