Examples of Cancer Disparities
Although cancer incidence and mortality overall are declining in all racial/ethnic groups in the United States, certain groups continue to be at increased risk of developing or dying from particular cancers.
Some key cancer incidence and mortality disparities among U.S. racial/ethnic groups include:
- African Americans have higher death rates than all other groups for many, although not all, cancer types.
- African American women are much more likely than white women to die of breast cancer. The mortality gap is widening as the incidence rate in African American women, which in the past had been lower than that in white women, has caught up to that in white women.
- African Americans are more than twice as likely as whites to die of prostate cancer and nearly twice as likely to die of stomach cancer.
- Colorectal cancer incidence is higher in African Americans than in whites. Incidence in all groups is declining, but the difference between the groups remains.
- Hispanic and African American women have higher rates of cervical cancer than women of other racial/ethnic groups; African American women have the highest rates of death from the disease.
- Hispanics and American Indians/Alaska Natives have the highest rates of liver and intrahepatic bile duct cancer, followed by Asian Pacific Islanders.
- American Indians/Alaska Natives have higher death rates from kidney cancer than people of other racial/ethnic groups.
- Both the incidence of lung cancer and death rates from the disease are higher in African American men than in men of other racial/ethnic groups.
Other notable examples of disparities include:
- The incidence rates of colorectal, lung, and cervical cancers are much higher in the Appalachian region of Ohio than in wealthier and more populated areas of the state.
- African American women are nearly twice as likely as white women to be diagnosed with triple-negative breast cancer, which is more aggressive and harder to treat than other subtypes of breast cancer.
- There are large differences among racial/ethnic groups in colorectal cancer screening rates, with Spanish-speaking Hispanics less likely to be screened than whites or English-speaking Hispanics.
- Rates of colorectal cancer deaths among those younger than 65 (“premature” deaths) are higher in states with the lowest education levels than in those with higher levels. People with more education are less likely to die prematurely of colorectal cancer than those with less education, regardless of race or ethnicity.
- Behaviors that increase cancer risk, such as smoking and drinking alcohol, may be more prevalent among lesbian, gay, and bisexual youths than among heterosexual youths.
Addressing Cancer Disparities
Because many different factors can cause cancer disparities—in particular, poverty and a resultant lack of quality medical care—addressing them is not simple or straightforward. Nevertheless, researchers are identifying ways to address the most critical factors in specific disparities and are already meeting with some success.
One approach is to specifically address access to care. For example, in 2002, seeking to address disparities in colorectal cancer among African Americans, Delaware created a statewide colorectal cancer screening program that paid for screening and treatment and made patient navigators available to coordinate screening and cancer care. By 2009, this program had eliminated disparities in screening rates, cut the percentage of African Americans diagnosed with cancer that had already spread, and almost completely abolished racial/ethnic differences in colorectal cancer incidence and mortality. Similar efforts are under way to address cancer disparities among rural populations.
Researchers are also addressing biological differences in cancers across racial/ethnic groups. For example, they are identifying genetic variants that may explain the higher risk of prostate cancer among African American men compared with white men. Researchers are also looking at other molecular differences that may explain why African American men tend to get more aggressive prostate cancers than white men. Studies of this type may eventually help identify ways to reduce risk among African American men.