An increased understanding of why cancer develops more often and survival is poor among some US ethnic and racial minority groups is leading to new programs nationwide to address the problem.

African Americans are more likely to develop cancer than people of any other racial and ethnic group, according to the American Cancer Society's (ACS) Cancer Facts & Figures 2002.

African Americans are also about one-third more likely to die of cancer than whites and more than twice as likely to die of cancer as Asian/Pacific Islanders, American Indians, and Hispanics.

In some areas of the US, colon cancer rates among Hispanics are rising, even while colon cancer rates are dropping generally.

Scientists have found some genetic differences among people of different ethnic and racial backgrounds, but those generally are not the most important reasons why minorities fail to survive many cancers as long as do others, noted one expert.

"Where patient care is equal, treatment and outcome are equal," said Otis Brawley, MD, associate director of the Winship Cancer Institute at Emory University.

For example, today, African-American women are about twice as likely to die of breast cancer as white women, but until about 1980, their survival rates were equal, Brawley noted.

But it wasn't genes that changed around 1980, he added.

Instead, improved breast surgery techniques became more common then, new chemotherapy drugs improved survival times, tamoxifen began reducing recurrence rates, and widespread use of mammography began to more often detect breast cancer in its earliest, most curable stages.

But women too poor to have insurance or adequate income to pay for those advances didn't benefit from them, noted Brawley.

Because there is a larger portion of low-income earners among African Americans, it can seem that race is the reason for worse cancer rates, when it mainly is poverty, he added.

Brawley noted that among US military personnel — who all have access to the same quality of care — breast cancer survival rates remained the same among African American and white women, even after 1980.

Low income and less education — more common among some minority groups — also can make a difference, translating into more diets high in fat and low in fruits and vegetables, and more smoking, both known to increase risk of several cancers.

At Emory, Brawley and colleagues are using money from the tobacco settlement to provide low-income Georgia residents with screening and treatment, and cancer prevention information.

At the ACS, programs are designed to be "culturally appropriate" — respectful and supportive of different communities' values — so the programs' messages will be well-received, noted Eve Nagler, MPH, CHES, director of special populations in the ACS cancer control department.

Ongoing projects include prostate cancer programs designed for African-American men, Spanish-language screening programs, cervical cancer screening programs for American-Indian women, and survivor support programs among those and other groups.

Nagler noted that the ACS also lobbies Congress to make treatment available for low-income women found to have breast or cervical cancer, and to aid the uninsured.

Cancer information specialists at the ACS can send out most basic cancer documents in English or Spanish, and can answer cancer questions from callers speaking any language.

Those and other programs are a large and growing part of the ACS' efforts to meet its year 2015 goals of dropping cancer death rates by 50%, cancer occurrence rates by 25%, and improving cancer patients' quality of life measurably by 2015, noted Nagler.

The unequal burden of cancer within minority and medically underserved communities must be reduced if the ACS is to meet those goals because that burden is now such a large part of the total cancer picture, she added.

"The ACS programs now in place are making a difference, and we will continue to do what is necessary until these disparities are eliminated," Nagler concluded.