Understanding Cancer Disparities
Cancer is a disease that can affect anyone, but it doesn’t affect everyone equally. Many social structures and practices can limit a person’s access to health care needed to prevent, treat, and survive cancer. These obstacles may include racism, discrimination, poverty, lack of access to healthy and affordable foods, low quality education and housing, and jobs with inadequate pay.
When the quality of health care differs between people because of racism or other forms of discrimination based on their income, health insurance coverage, race/ethnicity, gender identity, age, disability status, health insurance coverage, or where they live, it’s called a health disparity.
Health care disparities can affect every step of cancer care — from prevention and screening to the quality of life after cancer treatment, which means disparities in care can affect who develops and dies from cancer.
Cancer Disparities Facts & Figures in Brief
Highlights: Cancer Facts & Figures for African Americans, 2019-2021
Every 3 years, we publish the report Cancer Facts & Figures for African Americans and also write a scientific paper published in the American Cancer Society peer-reviewed journal, CA: A Cancer Journal for Clinicians.
These publications provide the most recent data on cancer incidence (newly diagnosed cases), mortality, survival, screening, and risk factors for African Americans.
Black people have the highest death rate and shortest survival of any racial/ethnic group for most cancers. This is due to disproportionate poverty and underlying systemic discrimination that reduce access to cancer screening, care that allows for early detection, and appropriate, high-quality treatment.
For non-Hispanic Black men, compared to non-Hispanic White men:
- Incidence and death rates are higher for the most common cancers (prostate, lung, colorectal).
- The incidence rate of prostate cancer is 76% higher and the death rate is more than double.
For non-Hispanic Black women, compared to non-Hispanic White women:
- Death rates are 41% higher for breast cancer and almost double for uterine corpus (endometrial) cancers, despite similar incidence rates for both types.
For non-Hispanic Black people, compared with non-Hispanic White people:
- Kaposi sarcoma, myeloma, and stomach cancer incidence rates are almost 2 to 4 times higher.
- Diagnosis of cancer at a higher, or later, stage is more common.
Highlights: Cancer Facts & Figures for Hispanics/Latinos, 2018-2020
For Spanish-speaking readers >>Datos y Estadísticas sobre el Cáncer entre los Hispanos/Latinos
Every 3 years, we publish the report Cancer Facts & Figures for Hispanics/Latinos and also write a scientific paper published in the American Cancer Society peer-reviewed journal, CA: A Cancer Journal for Clinicians.
These publications provide updated cancer information on cancer occurrence and risk factors in the Hispanic/Latinx population, as well as information about prevention, early detection, and treatment.
For Hispanic people, compared to non-Hispanic White people:
- Poverty rates in 2016 were more than double—19% compared to 9%. Socioeconomic disparities among Hispanic people are strongly linked to long-standing systemic racism, which prevents Hispanic people from receiving equitable access to high quality cancer care for prevention, early detection, and treatment.
- Incidence rates are lower for the four most common cancers (female breast, colorectal, lung, and prostate). This reflects the lower risk for these cancers among foreign-born people, who account for about a third of the Hispanic population.
- Incidence rates are higher for infection-related cancers—stomach, liver, and cervical—as well as for gallbladder cancer.
- Disparities in 5-year survival rates are largest for melanoma. About 88% of Whites live at least 5 years after being diagnosed with melanoma, compared to only 79% of Hispanics.
Hispanic people born in the US may have cancer incidence rates more like non-Hispanic white people—or even higher. This is partly due to US acculturation—the adoption of attitudes, values, customs, beliefs, and behaviors of people in the US. When combined with socioeconomic disparities and systemic racism, acculturation leads to a higher burden of cancer risk factors, such as obesity and type 2 diabetes in US-born Hispanic people.
Certain Hispanic subpopulations have substantially varying cancer rates and risk factors. For example, lung cancer incidence rates are higher in Cuban men than in other Hispanic groups combined due to higher historical smoking rates.
Hispanic children and adolescents have higher rates of leukemia than all other racial and ethnic groups in the US. They have nearly double the rate in Black children, who experience the lowest rates.
ACS Cancer Prevention Studies
Volunteer Participants in CPS-II and CPS-3 Allow for Ongoing Studies About Disparities in Cancer Risk and Survival
Epidemiology researchers in the ACS Population Science department continually analyze data from the Cancer Prevention Study II (CPS-II) and CPS-3 to better understand factors that contribute to disparities.
Currently, we’re looking at:
- How living in a rural community affects the social determinants of healthy eating and active living and how together these factors contribute to the risk of developing or dying from cancer.
- How the COVID-19 pandemic has affected diet quality, physical activity, mental health, and cancer screening practices in different populations. Longer term, our epidemiologists will be able to understand the ongoing health effects related to COVID-19 in both the general population and in cancer survivors.
- The use of technology to help certain medically underserved populations get better access to evidence-based ways that help people adopt behaviors that help reduce the risk for developing cancer and improve their survival if they develop it, such as stopping smoking and increasing physical activity.
We’re also adding new questions to the 2021 survey that will help us understand perceived discrimination and its impact on health by asking participants where, why, and when they have felt discrimination.
Spotlight on ACS Research Publications & Podcasts
The American Cancer Society (ACS) employs full-time researchers and funds scientists across the United States who relentlessly search for answers to help us better understand cancer, including cancer health disparities. Here are some highlights of their work.
More Information About Cancer in LGBTQ People May Help
“We are quantifying cancer among people of diverse sexual orientations including heterosexual, bisexual, and lesbian women. Additionally, we are identifying risk factors for cancer that are unique to bisexual and lesbian women, including those linked to societal stigma and discrimination. Our findings are highlighting new avenues for health equity and interventions for all people, regardless of sexual orientation.” —Brittany M. Charlton, ScD
See the highlight about Dr. Charlton's published study.
I Can PIC Tool Improves Cancer Patients’ Insurance Choices
“We developed a web-based decision aid, Improving Cancer Patients’ Insurance Choices (I Can PIC), and evaluated it in a randomized trial. I Can PIC provides health insurance information, supports patients through managing care costs, offers a list of financial and emotional support resources, and provides a personalized cost estimate of annual health care expenses across plan types.” —Mary Politi, PhD
See the highlight about Dr. Politi's published study.
1 in 3 Women with Early-Stage Breast Cancer Delay Chemotherapy After Surgery in Ethiopia, Sub-Saharan Africa
“Reducing the growing burden of cancer in sub-Saharan Africa requires coordinated efforts and commitments from the local governments, national and international private and public health agencies, and philanthropists.”—Ahmedin Jemal, DVM, PhD
See the highlight about Dr. Jemal's published study.
Community Health Advisors in Church
“We train lay individuals in the churches to serve as community health advisors and so these are the regular folks who are in the church, they don’t necessarily have a health background or specific health training. They go through a 13-module training and certification process so that they can become and play the role of the community health advisor in the church. This is the peer that people trust and go to for cancer info . . . they conduct a series of educational workshops.”—Cheryl Knott, PhD
Listen to the podcast with Dr. Knott
Achieving Cancer Health Equity in the Muslim American Community
“We’ve found this in some of our participants—the belief that God is punishing the person for past deeds by giving them cancer. And this is not only unsettling for the patient; it’s unsettling for providers. So how do you approach this and not offend the person? And the potential for the person to draw meaning from the cancer experience. How do you turn it around from persecution to an opportunity for meaning-making?”—Mark Lazenby, PhD, APRN, FAAN
Listen to the podcast with Dr. Lazenby and Aasim Padela, MD, also an ACS grantee.
Extramural Discovery Grants in Cancer Disparities Research
The American Cancer Society funds scientists who conduct research about cancer at medical schools, universities, research institutes, and hospitals throughout the United States. We use a rigorous and independent peer review process to select the most innovative research projects proposals to fund.
68
Grants
Total Grants in Effect for Disparities Research as of March 1, 2021
$52
Million
Total Grants Funding for Disparities Research as of March 1, 2021
Advocating for Cancer Equity
Disparities Research Informs Advocacy and Policy Actions
The American Cancer Society Cancer Action Network (ACS CAN) is the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society. Its role is to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. American Cancer Society (ACS) researchers collaborate with ACS CAN staff to explore how and why certain groups of people in the US are not benefitting from health care services such as cancer prevention, early detection, and treatment.
ACS CAN is attacking disparities by changing or adding new evidence-based public health policies at the local, state, and federal levels. The goal of ACS CAN is to reduce these disparities and improve health outcomes for all US population groups regardless of race, ethnicity, gender, age, sexual orientation, socioeconomic status, or zip code.
For more information, visit the ACSCAN web site at www.fightcancer.org
Reducing Barriers
Patient Enrollment in Cancer Clinical Trials
“Medicaid recipients in many states . . . are essentially barred from enrolling in clinical trials. ACS CAN developed some model legislation over the past year, and our state colleagues have worked to get that introduced. And we actually got legislation passed in three states—Colorado, Minnesota, and Illinois—which would require their state Medicaid plans to cover those routine care costs of cancer clinical trials."
—Mark Fleury, PhD, Policy Principal at ACS CAN
Health Equity at ACS
We’re Learning How to Better Integrate Health Equity into Our Organizational Practices and Culture
American Cancer Society (ACS) researchers and the researchers we fund through extramural grants are working to better understand what health disparities exist, what causes them, and how to decrease them.
Our research shows that while overall cancer mortality rates are dropping, populations who are marginalized are bearing a disproportionate burden of preventable death and disease. If we are to further reduce deaths from cancer and achieve our mortality goal of reducing cancer deaths by 40% by 2035, we need to make sure everyone has the ability to benefit from the advances in the prevention and treatment of cancer.
A partnership and 3-year grant (2021 to 2023) with the Robert Wood Johnson Foundation (RWJF) is helping us do just that. RWJF is the nation's largest philanthropic organization dedicated solely to health in the United States. They’re committed to working with others to build a “Culture of Health” that provides everyone with a fair and just opportunity to be as healthy as possible.
The purpose of RWJF’s partnership with ACS and our nonprofit, nonpartisan affiliate, the American Cancer Society Cancer Action Network (ACS CAN) is to advance the culture of health equity, integrate it into our organization, and make it a shared value for ACS and ACS CAN volunteers, staff, partners, and the community at the national, state, and local levels. We are doing this through trainings and other educational opportunities for volunteers and staff to deepen their health equity knowledge and skills.
We are also piloting Health Equity Community Projects, a collaboration between ACS, ACS CAN, and community partners in select cohorts across the nation. The goal of this partnership is to explore, identify, and implement community-driven solutions that address specific social and structural factors around cancer disparities.
More About Our Cancer Health Disparities Work
From advocating for change to fundraising for research, we’re working hard to address cancer health disparities.