An NCI-designated Comprehensive Cancer Center
By Saundra Young | February 26, 2018
Erhunmwunsee-Loretta Loretta Erhunmwinsee, M.D.
Loretta Erhunmwunsee, M.D., has her work cut out for her. 
She’s one of a few female African-American thoracic surgeons in the country, and is on a mission to eliminate health inequities among minority and under-resourced populations. Because while lung cancer rates are declining here in the United States, disparities still exist along racial and socioeconomic lines, especially for African-Americans.
“The data has shown us that minorities and those with low education, low income or those who live in poor neighborhoods don’t get the same level of care,” Erhunmwunsee said. “If you are African-American, poor or undereducated, you are less likely to get surgery, chemotherapy or radiation therapy – meaning you are less likely to get the appropriate treatment.”
According to Erhunmwunsee, hospitals in poor communities generally have fewer resources and may be simply unable to provide the same level of care.
There is also data that suggests that often when African-American patients seek treatment, their disease is already advanced.
Patients who present later, who get less treatment or who go to under-resourced hospitals have poorer outcomes.”
Unfortunately, African-American and poor patients are more frequently in these categories.
But just as important is the fact that African-Americans often do not participate in clinical research.
“African-Americans, those who are poor, even Latino-Americans, and those who have less education are less likely to be in our clinical trials,” she said. “So we have these trials that are showing us how to better treat patients but the most vulnerable patients may not be in those trials.”
Whatever the reasons, Erhunmwunsee, who has been at City of Hope for nearly three years, and is an assistant professor of surgery, says not enough is being done to address the issue and that the first step is to acknowledge the problem.
She feels health care providers share some of the blame, and have to be part of the solution.
“We know that physicians sometimes have implicit bias and may assume that a person of a certain class or race might have less understanding or a decreased ability to withstand surgery or certain complications. This bias could lead to a patient being less likely offered a particular procedure or treatment.”
She’s part of a City of Hope team that routinely engages the community in various initiatives in an effort to stamp out disparities. 
Victoria Seewaldt, Ph.D., the Ruth Ziegler Chair in Population Sciences, chairs the Department of Population Sciences at City of Hope and mentors young scholars like Erhunmwunsee. 
“I went to a surgery meeting and heard Dr. E. speak,” Seewaldt recalled. “Her voice resonated with me. She spoke with wisdom and power and strength, so I went to talk with her and we are now friends, collaborators.”
Seewaldt, a breast cancer specialist, says the rate of nonsmoking related cancer needs the attention of doctors like Erhunmwunsee.
“Men and women of color face disparities in neighborhoods, environmental exposures that may increase risk of nonsmoking related cancer,” Seewaldt said. “These disparities are worsened by lack of access. A person of color with a chronic cough may be ignored. For this, we need physicians like Dr. Erhunmwunsee who represents the diversity of our communities.”
According to Otis Brawley, M.D., chief medical officer at the American Cancer Society (ACS), there will be more than 154,000 lung cancer deaths this year. He says preventing smoking is crucial for closing the disparities gap.  
“It’s going to take a few more years of people not smoking,” Brawley said. “We’ve got good data to show equal treatment yields equal outcome and we’ve got good data to show there is not equal treatment.”
Brawley feels the role hospitals play is undeniable.
“Hospitals that poor people go to have to see more volume and the pathologist can’t take nearly as much time with each specimen as hospitals that middle class insured people go to.”
But Erhunmwunsee sees signs of encouragement among the frustration.
“People are living longer with lung cancer than they ever have before and that is so exciting. We’ve got immunotherapy, targeted therapy, minimally invasive surgeries. We have so much that can help positively impact a patient’s life,” she said. "But if the most vulnerable don’t get access to those treatment options or to the clinical trials then the gap between the haves and the have nots will only widen.”
What she’s sure of is that it’s time to act.
“The right thing to do is to engage our communities, acknowledge that there is a problem, make a concerted effort to get vulnerable patients appropriate lifesaving therapy and into clinical trials. We also need to help physicians, providers and health systems understand that certain groups are more at risk and then get resources to those patients.”
Without those steps, she only sees the gap widening.
“It is certainly a tall order and the problem is challenging for sure. But satisfaction comes from fighting and ultimately beating a formidable foe. We have to keep pressing because our patients are worth it.”

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