Community and Research Perspectives on Cancer Disparities in Wisconsin

Abstract

Introduction: Significant disparities are apparent in geographic areas and among racial/ethnic minority groups in Wisconsin. Cancer disparities are complex and multifactorial and require collaborative, multilevel efforts to reduce their impact. Our objective was to understand cancer disparities and identify opportunities to collaborate across community and research sectors to address them.

Methods: From May 2017 through October 2018, we assembled groups of community members and researchers and conducted 10 listening sessions and 29 interviews with a total of 205 participants from diverse backgrounds. Listening sessions and interviews were scheduled on the basis of participant preference and consisted of a brief review of maps illustrating the breast and lung cancer burden across Wisconsin, and a semistructured set of questions regarding causes, solutions, and opportunities. Interviews followed the same structure as listening sessions, but were conducted between a facilitator and 1 or 2 individuals. Major themes were summarized from all sessions and coded. We used the Model for Analysis of Population Health and Health Disparities to identify areas for collaboration and to highlight differences in emphasis between community participants and researchers.

Results: Participants identified the need to address individual behavioral risks and medical mistrust and to build equitable multilevel partnerships. Communities provided insights on the impact of environment and location on cancer disparities. Researchers shared thoughts about societal poverty and policy issues, biologic responses, genetic predisposition, and the mechanistic influence of lifestyle factors on cancer incidence and mortality.

Conclusion: Listening sessions and interviews provided insight into contributors to cancer disparities, barriers to improving outcomes, and opportunities to improve health. The unique perspectives of each group underscored the need for multisector teams to tackle the complex issue of cancer disparities.

Figure 1

Female breast cancer mortality rate (Map A) and lung cancer mortality rate (Map B), Wisconsin, 2008–2013. The female breast cancer mortality rate is indirectly age standardized and smoothed using adaptive spatial filtering. The lung cancer mortality rate is indirectly age–sex standardized and smoothed using adaptive spatial filtering. A grid of points is used to estimate mortality rates continuously across the map, based on the 20 closest breast cancer deaths and the 40 closest lung cancer deaths. Red areas indicate higher rates than expected and blue areas indicate lower rates than expected, compared with the regional rate. Areas without color indicate rates close to the regional rate. Data source: State Vital Records Office, Wisconsin Department of Health Services 2008-2013 (12). Reprinted with permission of Yuhong Zhou, PhD, and Kirsten Beyer, PhD, MPH, MS, Medical College of Wisconsin.

Figure 2

Composition of listening sessions and interviews. A total of 205 participants answered semistructured questions about communities and cancer disparities in Wisconsin. Sixty-seven participants represented basic, population health, and clinical research, and 138 participants represented community perspectives. We also conducted a listening session at a coordinators meeting of Well Woman, the Wisconsin’s Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program.