For decades, lung cancer has been the leading cause of death from cancer for both Black and White men and women. But as of 2019, breast cancer became the leading cause of cancer death for Black women.
This shift is because of steep declines in the number of lung cancer deaths in recent years due to reductions in smoking, earlier diagnosis, and advances in treatment. Although the breast cancer death rate is also falling steadily (by a little more than 1% per year since 1995), the number of breast cancer deaths continues to rise because of the aging and growth of the population.
These are some of the key findings in Cancer Facts & Figures for African American/Black People 2022-2024, the consumer-friendly companion of the study “Cancer Statistics for African American/Black People, 2022,” published in the American Cancer Society (ACS) journal CA: A Cancer Journal for Clinicians. ACS researchers, including Angela Giquinto, MSPH, and Rebecca Siegel, MPH, update these publications every 2 to 3 years to keep tabs on progress and monitor inequalities in new cancer cases (incidence), deaths, survival, screening, and risk factors.
The Black population is the third largest racial/ethnic group in the United States (after White and Hispanic people). It includes African Americans, whose ancestors were brought to the US involuntarily as slaves; Caribbean Americans; and recent immigrants of African descent. As a whole, Black people are more likely to die from most cancers and to live the shortest amount of time after a cancer diagnosis than any other racial/ethnic group.
Cancer is the second-leading cause of death in both Black and White people, after heart disease. The overall Black-White cancer disparity is slowly narrowing, mostly due to a steeper reduction in cigarette smoking by Black people than by White people in the 1970s and 1980s. This has resulted in a faster decline in lung and other smoking-related cancers among Black people.
A more rapid decline in prostate cancer mortality among Black men has also contributed to the decreasing overall disparity. However, the gap for many common cancers, including breast cancer, remains wide. Black women are 41% more likely to die from breast cancer than White women, despite being less likely to be diagnosed with it.
Reasons for continuing disparities are complex but are likely rooted in structural racism, which contributes to inequalities in the social determinants of health, including access to care. Socioeconomic differences are linked with having more risk factors for cancer and other diseases and less access to high-quality and timely cancer prevention, early detection, and treatment. The main cause is inadequate health insurance.
“African American people are overrepresented in states that have not expanded Medicaid,” said Karen Knudsen, MBA, PhD, ACS Chief Executive Officer. “Expanding access to care for all low-income persons and increasing trust in the medical community through provider education can substantially reduce the burden of cancer in African Americans.”
Because of such issues and barriers, Black people are:
ACS researchers note that only a small fraction of the racial differences in cancer deaths can be attributed to genetic differences.
“Future research should not only explore the influence of systemic racism on health, but also develop mechanisms to reverse course,” said Rebecca Siegel, MPH, senior ACS researcher on the study. “That could involve requirements for increased diversity in clinical trials, provider education, and health system financial incentives for the provisions of equitable care across the cancer continuum.
Prostate cancer is the most commonly diagnosed cancer in Black men, accounting for 37% of all new cancers. Although prostate cancer is also the most commonly diagnosed cancer in White men, incidence rates are 73% higher in Black men.
The prostate cancer death rate in Black men has dropped by more than 50% since its peak of 82 deaths per 100,000 in 1993. However, the decline in death rates for prostate cancer in Black men is slowing.
From 2010 through 2014, the death rate dropped by 5% each year, but the pace slowed to a decline of 1.3% a year from 2015 through 2019. That slowdown may reflect the increase in advanced-stage diagnoses for prostate cancer. Each year since 2012, the incidence of advanced cases has increased by 5% a year in Black men.
This increase in late-stage diagnoses likely reflects the reduction in screening following the US Preventive Services Task Force (USPSTF) recommendation in 2012 against routine prostate-specific antigen (PSA) testing. Testing blood for PSA levels can often help find cancer at an early stage, when it is only in the prostate (localized). However, concerns about overdiagnosis and overtreatment (the diagnosis and treatment of cancer that would never have caused harm) as a result of widespread PSA testing led to the change in the USPSTF guideline.
In 2018, the USPSTF revised the guideline again to recommend informed decision making among men ages 55 to 69. However, studies have found that Black men are less likely than White men to be informed about screening.
Prostate cancer death rates are more than twice as high in Black men than in White men. In fact, Black men have the highest prostate cancer death rate of any racial or ethnic group in the US. ACS researchers note that this disparity likely reflects less access to high-quality treatment, in addition to higher incidence. Studies show Black men diagnosed with advanced-stage prostate cancer are significantly less likely to receive any treatment compared with White men, even when they have similar health insurance.
The overall cancer incidence rate in Black men was 6% higher compared with White men during the period from 2014 to 2018. Specifically, Black men are more likely to be diagnosed with prostate, lung, colorectal, kidney, liver, and pancreatic cancer.
The overall cancer death rate in Black men was 19% higher than White men during the period from 2015 to 2019. Specifically, Black men had double the risk of dying from multiple myeloma and prostate cancer and almost 3 times the risk of dying from stomach cancer compared to White men.
Overall, Black women have an 8% LOWER cancer incidence rate compared with White women. Specifically, Black women are LESS likely to be diagnosed with breast and lung cancer.
However, Black women are MORE likely to be diagnosed with stomach, liver, and pancreatic cancer—all of which have low survival rates.
In contrast to the lower overall incidence rate, Black women have a 12% HIGHER overall cancer death rate than White women. Specifically, Black women have double the risk of dying from uterine corpus (endometrial) cancer and are 41% more likely to die from breast cancer even though their incidence rates are similar to or lower than those of White women.
The wide disparity in breast cancer death rates between Black and White women likely reflects fewer cancers being diagnosed at a localized (early) stage (57% in Black women compared with 67% in White women), as well as less access to high-quality treatment. Cancers diagnosed at a later, more advanced stage are typically more complicated to treat. Black women have a lower 5-year survival rate overall and for every every stage of diagnosis. About 82% of Black women live at least 5 years after their initial breast cancer diagnosis, compared to 92% of White women.
Higher death rates from breast cancer among Black women are also likely related to:
Expected new cases of cancer in Black people 2022: About 224,080
Expected cancer deaths among Black people in 2022: About 73,680
Colorectal cancer is the third most common cancer and the third-leading cause of death from cancer in Black men and women, similar to the general population.
Multiple myeloma incidence rates and death rates are about 2 times higher in Black people than in White people. Incidence rates for people younger than age 50 are almost 3 times higher for Black men and more than 3 times higher in Black women.
Geographical location affects rates of new cancer cases and deaths. Variations across states reflect differences in the prevalence of risk factors, such as smoking and obesity, as well as differences in public health policies, such as Medicaid expansion, that affect access to care.
The ACS is committed to reducing the racial disparity gap across the continuum of cancer care. Here are some ways the research teams are helping close the gap.
For more examples our work, see Cancer Disparities ACS Research Highlights.