Racial disparity in cancer death rates is decreasing, but African Americans continue to bear a greater cancer burden than whites, according to Cancer Facts and Figures for African Americans 2009-2010, the latest edition of the American Cancer Society's biannual report.

Cancer death rates among African Americans have been steadily decreasing since 1991. However, the numbers are still much higher than in whites. According to the report, cancer death rates in 2005 were 33% higher in African-American men and 16% higher in African-American women than in white men and women, respectively. Still, that gap is narrowing: in 2003, rates were 35% higher in African-American men and 18% in African-American women compared to whites. (See Cancer Facts and Figures for African Americans 2007-2008.)

“The disparity gap is narrowing in large part because there's been a more rapid decrease in tobacco-related cancer deaths among African-American men as compared to white men. However, the disparities in death rates between African Americans and whites continue to increase for cancers that can be most affected by early detection and treatment, such as breast and colorectal cancer,” says Ahmedin Jemal, PhD, Department of Epidemiology and Surveillance Research, American Cancer Society, one of the authors of the report.

According to the report, the most common cancers among African-American men in 2009 are projected to be prostate (34%), lung (16%), and colorectal (10%) cancer, and among African-American women, breast (25%), lung (12%), and colorectal (11%) cancer.

For all cancer types, African Americans are far more likely than whites to be diagnosed in advanced stages of disease, when the cancer is less treatable. African Americans are also less likely than whites to survive 5 years after a diagnosis, regardless of cancer type and stage of diagnosis, the report found.

The reasons are complex, the researchers say.

“Rates are driven by social and economic factors,” says Jemal. “In the African-American population, there's far less utilization of screening. For example, in 2005, 44% of African Americans were screened for colorectal cancer, compared to 51% of whites. There's a real need for programs that address that disparity.”

There are also significant differences in income and education, as well as barriers to high-quality health care. Lifestyle factors also play a role.

Being overweight or obese is a risk factor for many cancers, including breast, colorectal, uterine, esophageal, and kidney. And according to the National Health and Nutrition Examination Survey, 76% of African Americans are overweight and 46% are obese, compared to 66% and 33%, respectively, of whites. African Americans are also less likely to engage in physical activity. The National Health Interview Survey found that almost half of African-American adults reported no leisure-time physical activity. Exercise has been linked to a lower risk of some cancers.

“Many African Americans live in poor, urban areas where there are limited recreational opportunities, and they're less likely to find healthy foods like fruits and vegetables. There are a lot of environmental deterrents for persons residing in poor neighborhoods, from cancer prevention to early detection and treatment,” Jemal says.

The report is available at www.cancer.org/statistics.