Sometimes I don’t think we acknowledge and celebrate our successes. An example would be the decrease in the number of smokers in New York City, especially among young people. Too few of us are aware of this remarkable success.
Another example would be something that I have noted previously: there has been a significant decline in smoking related cancer deaths among African American men in the United States.
A paper in the current issue of Cancer, Epidemiology and Biomarkers now sets the record straight with respect to that second observation.
Unfortunately, the news is not all good. In cancers where screening for early detection is available, the impact of disparate care has led to an increase in the mortality gap between whites and blacks in this country for these cancers.
The researchers—who are from the epidemiology department at the American Cancer Society--examined the trends in cancer deaths in the United States from 1975 through 2004. They looked at cancer death rates and the differences between white American men and women, and African American men and women. They further divided the analysis into the rates for all cancers combined, for smoking related cancers and cancers where screening is available including prostate, colon and breast cancers. (Cervical cancers were excluded since there are few deaths in this country from cervical cancer.)
The findings were reasonably straight forward: death rates for all cancers in all groups declined over that time period, except for lung cancer in women. The declines were greater in men than women.
Since 1993, the gap in death rates between African American and white men has been closing for men and since 1997 for women. The real news was that there was a more rapid decrease in death rates from lung cancer and other tobacco related cancers in African American men than white men.
The bad news is that when it came to looking at death rates in screened cancers, the disparities have increased over the 30 year period for those cancers (breast, prostate and colon).
When the researchers delved further into the data, they found that a substantial decline in deaths from esophageal cancer—which is known to be related to cigarette smoking—accounted for 45% of the overall decline in the cancer death rates in African American men.
This news actually wasn’t news to me. I had previously written about this over a year ago in my blog, when I discussed the results of the 2007 “Report To The Nation” which is published every year by the American Cancer Society along with other organizations committed to reducing the burden and suffering from cancer:
“One of the items noted in the report—but that does not get a lot of press attention—is the significant decline from 1995-2004 in incidence rates of cancers in black men that are related to cigarette consumption.
“The examples that I would cite include: lung cancer, down 2.9% per year; oral cavity and pharynx, down 3.1% per year; esophagus, down 5.5% per year; larynx, down 2.8% per year.
“Those declines—which are modest from year to year, but substantial over a decade—will help reduce the especially high burden of cancer in this community.”
As the current research report points out, there has been a stunning decline in the number of black men who smoke. In 1974, 53% of African American smoked. In 1995, it was 32%, and in 2004 24%. For white men, the comparable numbers are 42%, 26%, and 22%. The message here is that a large number of black men listened to the message about the dangers of smoking, and quit. The results are what we now see: a significant decline in the rates of death from tobacco related cancers.
But the news on the screening side isn’t as good. Blacks are less likely than whites to get screened, and that disparity shows up in the widening gap in death rates. They are also less likely to receive appropriate treatment in a timely manner. (I should point out that the authors state that mammography rates in white and African American women are essentially the same. For reasons that I won’t go into here, I don’t agree that the survey results that serve as the source for those numbers reflect the real situation “on the ground”. See my recent blog on that topic.)
So let’s take note of our successes, but also be aware of our shortcomings.
A community has heeded the message and taken control where they could take control. Black men have substantially decreased their smoking rates, and the benefit is that many fewer are dying of tobacco-related cancers. Just think of what that means in a group that has for so long been victimized by an unacceptably high rate of death from cancer. Think of the lives saved and the impact of those lives on families, friends and the community.
Unfortunately, when it comes to cancers we can prevent and/or detect early, the news is not as good.
It’s obvious we have a long way to go, but I am heartened by the observation that when we make an impact on behaviors, we make an impact on life. We have demonstrated success. People have listened to the message about smoking.
Now let’s meet the challenge and take the next step. Let’s address and further reduce the disparities for cancers where we know that screening can save even more lives.
As I have written before, we should accept nothing less.