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Racism and cancer care:
a call for recognition and reform

Bruce A. Chabner

For most Americans, the recognition that racism continues to permeate every aspect of American life became unavoidable as the nation watched the murder of George Floyd at the hands of police. The 8 minutes and 46 seconds that it took to drain the breath from Mr. Floyd raised the national consciousness about the pervasive resurgence of explicit, deadly racism and has provoked a re-examination of virtually every aspect of our lives, from the very focused attention on policing, to broader issues of health care, housing, education, religious beliefs, and the very personal experiences of ethnic and racial minorities. The picture that has emerged gives cause for alarm and a call to action. The national dialog clarifies that structural racism suffuses every aspect of our lives, and health care has not been spared. The ongoing COVID pandemic provides a cogent example as the infection has taken a disproportionate toll on persons of color, Native Americans, and other marginalized populations, whether because of limited access to testing and care, predisposing conditions such as diabetes, hypertension, and asthma, congested housing, or jobs that expose workers to high risk. The truth is that we have inherited and promulgated a long-standing culture of inequality, a political system that established equal opportunity for white men of the landholding class, and a centuries-long history of dehumanization of Blacks, Latinxs, and Native Americans. That culture, embedded in our schools and religious institutions and nourished in our elite educational institutions, pervaded our industries and commercial sector, maintaining the negative stereotypes of minorities, about their motivation, their innate abilities, and their appropriate occupations. In the post-World War II years, the courts and the federal government have enforced legal remedies against discrimination, but the past 4 years have witnessed a relentless attack with clear racist overtones against public education, broader health care coverage, the press, and science and medicine, all under the guise of preserving law and order and protecting personal liberties. The current political climate has only encouraged discriminatory behavior and has brought to the surface the underlying anger and racism of a major segment of America. While our society at large is wrestling with conflicting attitudes toward race and equality, so the medical establishment has been forced to face the same issues in the context of medical care and the long-standing health disparities that exist in a first-world country that has been an innovative leader in every aspect of medicine. For those of us concerned with cancer, it is the right time to examine how racism affects the prevention, treatment, and delivery of care to minority communities, and to what extent we have adequately incorporated a culture of equity in all phases of our work and our personal lives. To this end, The Oncologist will encourage the submission of papers on a broad spectrum of topics, from disparities in outcomes, to the recruitment and training of minority cancer physicians and scientists, to the personal experiences of minority professionals as they practice cancer medicine and pursue careers in the academic community. We will ask each author to relate in a very personal way their experiences and feelings about racism as it affects their own personal and professional lives. It is our firm belief that beyond the legal and institutional changes needed to establish true equity for minorities, a significant cultural shift must occur in the minds and hearts of all American men and women if we are to put racism behind us. The words of Dr. Martin Luther King Jr. set us on an important path for our pursuit of equity in outcomes, irrespective of minority status, and in career opportunities in cancer medicine. “Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality”.

The Oncologist 2020; 25: 729.

Chi è Bruce Chabner? È certamente uno degli oncologi più noti negli Stati Uniti.

Ha diretto per molti anni la Division of Cancer Treatment del National Cancer Institute di Bethesda, Maryland. Ha poi diretto la Ricerca Clinica del Massachusetts General Hospital Cancer Center a Boston, insegnando Oncologia Medica all’Harvard Medical School.

Per darvi un’idea della sua competenza e autorevolezza basti pensare che è Associate Editor del “Goodman & Gilman’s, The Pharmacological Basis of Therapeutics”, che è “la bibbia” dei farmacologi avendo curato i capitoli relativi alle terapie oncologiche.

Potrei scrivere pagine descrivendo i suoi contributi medico-scientifici e i ruoli che ha avuto nello sviluppo di un’oncologia moderna basata sull’applicazione della ricerca biologica e farmacologica in clinica. Ho avuto il privilegio di lavorare con lui molti anni fa al National Cancer Institute di Bethesda e ho quindi avuto modo di apprezzare non solo le sue capacità scientifiche, ma anche la sua onestà intellettuale e il suo forte desiderio di applicare tutte le nuove conoscenze ai malati di cancro, indipendentemente dal colore della loro pelle, della loro etnia e delle condizioni economico-sociali.

Mi ha fatto quindi molto piacere leggere l’Editorial, che si capisce essere ispirato dalla sua esperienza clinica quotidiana.

Considerata la sua statura medico-scientifica credo che il suo appello a che l’oncologia e più in generale la medicina affronti concretamente il tema del razzismo e della ingiustizia sociale associata ad esso sia di particolare interesse. Bruce, come Editor di Oncologist invita gli oncologi a riflettere su come il razzismo abbia un impatto nella prevenzione e nel trattamento delle malattie tumorali e a considerare la necessità di un cambiamento culturale, anche attraverso la pubblicazione di ricerche su questi temi.

Maurizio D’Incalci

Dipartimento di Oncologia

Istituto di Ricerche Farmacologiche
Mario Negri IRCCS, Milano