By Carol DeSantis, MPH
In conjunction with Black History Month, the American Cancer Society has released Cancer Facts & Figures for African Americans, statistics published every 2 years. The 2013 issue reveals encouraging cancer trends for African Americans, as well as areas where significant disparities remain or are growing. Cancer disparities, or health inequity, are caused by a number of societal problems that result in greater suffering and more people dying from cancer.
Death rates drop, but inequity remains
The great news is that overall cancer death rates have steadily decreased for African American men and women. In fact, the most recent data show that death rates dropped faster for African American men than men in any other racial or ethnic group. That's caused the disparity in cancer death rates between African American and white men to shrink considerably. Cancer death rates among African American women are declining at a similar rate as those of white women.
Despite these declines, however, death rates for all cancers combined remain 33% higher in black men and 16% higher in black women, compared to white men and women. African American men also have higher death rates for most of the major cancer sites (including lung, prostate, colon/rectum, liver, pancreas, and others). Notably, the higher overall cancer death rate in African American women compared to white women occurs despite lower incidence rates for all cancers combined and for breast and lung cancer.
For African American men, the drop in cancer death rates is mostly due to decreases in lung cancer; other smoking-related cancers like oral cavity, pharynx, larynx, esophagus, pancreas, bladder, and kidney; and prostate cancer. Remarkably, the disparity in lung cancer death rates among black and white men has been cut in half for men overall, and has been eliminated in younger adults (ages 20-39). This progress is mostly due to the fact that more African American men are quitting smoking, compared to white men. Although African American men have historically higher smoking rates compared to white men, over the last decade smoking rates have become more similar. In addition, smoking rates are lower among African American than white high school students. It is believed that if current smoking trends persist, racial differences in lung cancer death rates will be eliminated in the next 40 to 50 years.
Disparities increase for breast and colon/rectal cancers
On the other hand, the racial disparity has widened for death rates for breast and colorectal (colon) cancer - cancers for which screening tests and treatment truly make a difference. African American women are believed to get mammograms less often and are less likely to quickly follow up on abnormal results, which could result in a later, more advanced diagnosis that makes breast cancer harder to treat. Colorectal cancer screening rates are also lower in blacks compared with whites (56% vs. 62%, respectively). Furthermore, dramatic improvements in breast and colorectal cancer treatments have been introduced over the last two decades, but not all people are able to afford, are offered, or can even get to these treatments.
Disparities in breast and colorectal cancer may also, in part, reflect high rates of obesity found in the African American community. Obesity rates have increased significantly for both African American men and women from 1999 to 2010, and recent data show that half of African Americans are now obese (compared to 35% of whites). Obesity increases the risk for both of these cancers and may also be associated with higher death rates.
Socio-economic status and related behaviors influence rates
So what is the bottom line? Why have African Americans been unduly burdened by cancer with higher death rates, later stage at diagnosis, and poorer survival for most cancer sites compared to whites? We think it's mostly because of differences in socio-economic status rather than biological or genetic factors. African Americans are significantly more likely to be poor and uninsured compared to whites. Poor people have less access to quality health care (including cancer screening and treatment) and are more likely to engage in unhealthy behaviors, such as smoking and physical inactivity. We also know that uninsured people are more likely to be diagnosed with advanced cancer.
While overall racial disparity in cancer mortality has narrowed, health equity is not yet a reality. It is hoped that the passage of the Affordable Care Act will increase the availability and affordability for quality health care, including cancer screenings and treatment, for all people in the U.S., which in turn will reduce health disparities.
For more information about American Cancer Society research aimed at ending disparities in health, click here.
To read the cancer.org news story about the publication, click here.
DeSantis is an epidemiologist for the American Cancer Society.