Do We Have the Will to Address Inequality in Precision Oncology? A Conversation with Dr. Karen Winkfield

In this episode, we are joined by Dr. Karen Winkfield, Executive Director of the Meharry-Vanderbilt Alliance, appointee to President Joe Biden's National Cancer Advisory Board, and co-host of the weekly podcast, 3 Black Docs, which is dedicated to educating the community about health and health disparities in an approachable and entertaining way.

Dr. Winkfield’s commitment to her calling was clear by the fact that she joins us during her vacation to discuss racial disparities in the healthcare system that prevent many Black patients from seeking and receiving appropriate care. She tells us that she didn’t discover her calling early and, due to family and cultural barriers of her own, she almost didn’t pursue it at all. In fact, it took the support of a dedicated high-school teacher and nine emotional years to finish her undergraduate degree in biochemistry to get her where she is today as a practicing radiation oncologist.

Off the top we ask Dr. Winkfield what can be learned from greater participation of underrepresented groups in clinical trials or greater participation in the healthcare system. She notes that Black people are still dying of cancer at a much higher rate than the rest of the population, and while there are some biologic reasons, much of the cause is under-representation in cancer clinical trials.

We point out her step-by-step plan to address this type of imbalance in the healthcare system, and we are reminded that this is nothing new as she has been working to help address it for decades. She says, "Okay, I laid out a plan, but there's been a plan out for ending cancer disparities for over 20 years." The unequal burden document that was essentially kind of written by the Institutes of Medicine. Congress actually was the one who said, "Hey, we need to kind of understand what's going on with this cancer disparities thing." The whole plan is outlined.

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Part of what the challenge is now is, do we have the will, do we have the will to do what is needed? Yes, I mean, there are those of us who've been kind of yelling from the mountaintops for decades now that we need to do something different because people are dying.”

She goes on to explain that balancing disparity isn’t as easy as, say, offering translation services, because institutionalized racism runs so deep that it presents barriers at every step. For instance, she says that if you look at the Cancer Genome Atlas Program, which has over 11,000 primary cancer samples, only 25 of those specimens are from prostate cancers derived from Black men, despite the fact that Black men not only have a much greater risk of developing prostate cancer, probably twice as high as any other racial ethnic group, and they're two-and-a-half times as likely to die of prostate cancer. She says, in America, your wealth directly impacts your health. Your zip code impacts your outcome more than your genetic code.

We naturally asked what role technology can play in eliminating healthcare disparities, and she says that without more representative patient samples, trials and access, precision medicine can never be precise.

In fact, she believes precision medicine can actually deepen the divide if it is not used with precision in terms of the whole person.

Where do they come from? What are barriers to them accessing precision medicine, such as transportation or even paying for parking?

Dr. Winkfield is a strong proponent of navigators who help cancer patients overcome those institutional barriers to ensure that they have equal access to the promise of precision medicine. She says, “These are the things, the social determinants of health, if we can stop and just see the person in front of us and say, what is it that you need to help you along your cancer journey? That to me is being precise.”