By: Frankye Myers, Riverside Health Chief Nurse Executive
With incidence rates on the rise for many common cancers, it’s critical for health care leaders to look at disparities among those affected by these diseases, noting differences in demographics such as age, sex, ethnicity and race. Armed with this information, we can make significant progress in cancer prevention and early detection among high-risk groups. At Riverside Health, we are committed to proactive, patient-centered care that addresses the individual challenges faced by people across the communities we serve.
A Growing Concern
One significant trend that requires an urgent response is revealed in the most recent statistics from the American Cancer Society (ACS), which show a troubling rise in cancer among women younger than 65. While females under age 50 have long had a higher incidence rate than males, mostly due to breast cancer, it increased dramatically from 51% higher than men in 2002 to 82% higher than men in 2021 (the most current year with data).
As the gender gap in this age group has been widening over the last two decades, an uptick in cancer among women ages 50-64 has also occurred. Since at least 1998, men ages 50-64 were more likely to be diagnosed with cancer than their female counterparts — 21% more likely in 2007, when the largest difference was seen. But beginning in 2011, the cancer incidence rate for females slowly increased until it caught up with the male rate in 2021.
Women of certain racial and ethnic backgrounds are even further disproportionately affected with regard to both cancer incidence and cancer mortality. According to the Cancer Facts & Figures 2025 report from the ACS, “Death rates for Native American and Black people are at least two times higher than White people for many largely preventable cancers.” For example, Black/African American women are twice as likely to be diagnosed with stomach cancer, and they are 2.3 times more likely to die from stomach cancer, as compared to non-Hispanic white women.
Understanding the Data
When looking at the numbers, Riverside Cancer Care Network’s Medical Director Aaron Chevinsky, MD, FACS, says it’s important to remember that increasing cancer incidence rates, especially among younger women, partially represent the result of improved screening in recent years. Still, there are other drivers behind the increase that we must examine and address.
“Cancers are based on fundamental factors, including genetic predisposition and modifiable risk factors like diet, environment and personal lifestyle choices,” Dr. Chevinsky says. “For example, obesity increases a woman’s circulating estrogen, which increases the risk for uterine and breast cancer. Often connected with this are high-fat diets and a lack of exercise, which further increase risk, as can the use of substances like alcohol and tobacco. In addition, as a population, girls are menstruating earlier and women are having children later, both of which are risk factors for breast cancer.”
These risk factors are compounded for minority and economically deprived populations, who often additionally experience a lack of health education, screening, insurance and access to sufficient care.
Furthermore, a false sense of security among young women often results from misconceptions that cancer only occurs in older people, or in people that have cancer in their family. “The vast majority of women who develop breast cancer — 80% or more — do not have a strong family history,” Dr. Chevinsky says. Despite this, knowing your family history is incredibly important.
“Overall, we’re looking at what we can do to identify and ameliorate the risks, and to help with screening to find cancer,” he says. “Because no matter what, one of the hallmark rules of cancer is that the earlier you pick it up, the better your chances are and the less rigorous the treatment will be in most cases.”
Reaching Out to High-Risk Populations
An effective avenue through which we can increase awareness about women’s risk factors for cancer and the importance of early detection is primary care. In addition to a healthy lifestyle, one of the most important steps a woman can take in protecting herself against cancer is to establish a relationship with a primary care provider at an early age. This allows a provider to more easily detect any changes to the patient’s baseline health, as well as to discuss personal risk factors that can determine the recommended timing and frequency of cancer screenings.
At Riverside, we’ve taken an additional step to identify hereditary breast cancer risk via our primary care and women’s health practices. A new program launched in 2024 targets our current female patients between the ages of 30 and 39 — before they begin having mammograms at the recommended age of 40, which is appropriate for women of average risk. During their birth month, these patients now receive a text message with the opportunity to complete a brief self-assessment screening to determine whether they may be at higher-than-average risk for hereditary breast cancer.
Those with high-risk results are offered free genetic counseling, funded by the Riverside Foundation, along with the opportunity for genetic testing. In its first year, 12,960 women were provided with the self-assessment screening, 2,818 of those completed the screening and 1,755 women determined to be high risk were referred to genetic counselors for assessment.
In our diagnostic centers, the Tyrer-Cuzick risk-assessment system is utilized to calculate the breast cancer risk of every woman who receives a screening mammogram. If she needs help completing the questionnaire, assistance is provided. During the mammogram visit, her risk results are sent to both her and the referring physician for any necessary follow-up.
Bridging the Gap Through Community Education and Outreach
But what about women who aren’t seeing a primary care or women’s health provider or coming in for routine mammograms? Connecting underserved women with the appropriate cancer screenings can be more challenging than reaching current patients, but it can be accomplished through focused community outreach efforts, like Every Woman’s Life (EWL), a public health program administered by the Virginia Department of Health.
As an EWL provider site, Riverside provides free breast and cervical cancer screenings to uninsured, low-income women in Virginia who meet the eligibility criteria. These patients are often referred to us through our strong partnerships with local free clinics across our service area. If diagnosed with cancer, EWL patients may be eligible for Medicaid to pay for treatment.
Another important aspect of our outreach is the offering of multiple women’s health events throughout the year. These are valuable opportunities to educate women on cancer prevention guidelines and self-advocacy, provide one-stop screenings and make follow-up arrangements for those who may be experiencing barriers to care.
Understandably, within under-resourced groups, cancer prevention is often not top of mind, with other daily needs taking precedence. But by making access easy, centralized, multilingual and free, we’re able to reach women in communities who may otherwise not receive needed care.
Innovative Solutions for Early Detection
Technological advances in early detection are also a powerful tool in improving outcomes for the increasing number of women affected by cancer. Our radiology team at Riverside has excelled in offering not only standard mammogram technology, but also digital, 3D and contrast-enhanced mammography, as well as ultrasound screening and MRI, for a comprehensive approach. An extra layer of scrutiny is now provided by an AI-assisted second reading of studies to ensure that nothing is missed.
Of course, for women, the importance of early detection isn’t confined to breast cancer. The new ACS data specifically showed that lung cancer among women surpassed that of men for the first time in 2021 for adults younger than age 65. Over the past several years, Riverside’s pulmonology, thoracic and primary-care teams have made incredible advances against this trend with a low-dose-CT screening program for those with a history of smoking, as well as the addition of a dedicated lung nodule clinic for the prioritized evaluation of suspicious findings.
Findings directed to the clinic are not only detected through lung-specific screening but can also be revealed incidentally through any other imaging study across the health system, which is important for younger people who may not yet qualify for lung cancer screening. These changes have dramatically shifted the majority of our newly diagnosed lung cancers from late stage to early stage — a huge victory.
Colorectal cancer is also an important area of focus for us, as Hampton Roads has been identified by the ACS as one of three hotspots for deaths related to this disease, which is rapidly rising among younger people. The recommended age for colonoscopy, the gold standard for colon cancer screening, has been lowered to 45 for those of average risk, and we are actively raising awareness to increase these screenings. Meanwhile, cancer researchers are working on the ability to identify colon cancer at earlier stages through blood tests.
Hope for the Future
Along with the development of earlier and more precise detection methods, breakthroughs in cancer treatment are also on the horizon. We’re actively involved in molecular medicine, which examines tumors on a molecular level for certain alterations, genes and mutations, and the use of precision medicine to apply this information to decisions about therapy. This approach has already revolutionized the care of melanoma, lung cancer, kidney cancer and many other cancers once thought to be terminal.
Riverside Health believes that research and cancer care go hand in hand, and we’re committed to improving patient outcomes through clinical studies whenever possible. In 2023, we established an exciting strategic alliance with UVA Health to expand our patients’ access to the latest clinical research trials and innovative care for complex conditions.
In combination with cutting-edge medical advances and a drive to make cancer screening and care available to all, a comprehensive team approach offers the most promising results for our patients and the greater community. “The key to cancer care and screening is multidisciplinary cooperation across all service lines within a health system, and the collaboration we have at Riverside is outstanding,” Dr. Chevinsky says.
As we move the needle forward to protect women from cancer, knowledge is power. We can use population-based cancer occurrence and outcome data, like the latest report from the ACS, to focus our efforts accordingly. In turn, we equip patients with their own knowledge and action steps, so that together we can fight cancer more effectively.