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Cancer Disparities Research

We put cancer disparities research into action by providing evidence to inform cancer prevention and control initiatives that promote health equity.

What We Do

Cancer disparities are adverse differences between certain population groups across the cancer continuum, from prevention and screening through treatment and survivorship. 

Cancer disparities may occur based on where people live, race/ethnicity, socioeconomic status (such as income or education level), sex, sexual identity or orientation, mental or physical ability, immigration status, and so on.

For example, from 2016 to 2020 colorectal cancer mortality rates were:

  • 23% higher in nonmetropolitan areas than in large metropolitan areas
  • 34% higher among Black populations than White populations

The American Cancer Society (ACS) Cancer Disparity Research team conducts transdisciplinary research to both:

  • Identify individual, social, biological, structural, and system-level determinants of health
  • Quantify the effect social determinants of health have on cancer disparities across the cancer continuum, including cause (etiology), prevention, screening and detection, incidence, stage at diagnosis, treatment, survivorship, quality of life after cancer treatment, and mortality

Our ultimate goal is to provide evidence to inform cancer prevention and control initiatives that promote health equity.

Glossary for Nonscientists

Featured Term: 
Social determinants of health

Social determinants of health are non-medical factors that influence health, the ability to function, risk for health problems, and quality of life. These include conditions in the environments where people are born, live, work, play, learn, worship, and age as well as the social, economic, and political systems that shape those conditions of daily life. 

Social determinants of health are comprised of structural inequalities,* social injustices, and institutional environments. 

The occurrence of cancer can be positively or negatively, affected by social determinants of health based on how they affect educational and job opportunities, income, housing, transportation, public safety, food security, social inclusion and non-discrimination, and access to affordable health services of high quality. Social determinants of health are closely linked with health disparities and cancer disparities.

*Bold terms are also in the glossary for nonscientists.

Factors Contributing to Cancer Disparities

Structural Inequality and Social Justice are social determinants that affect institutional environments

This graphic shows that: 

  • Social determinants of health are comprised of structural inequalities, social injustices, and institutional environments. 
  • Structural inequalities in an area (such as the number of hospitals or safe neighborhoods to play and exercise in) and social injustice (such as racism, homophobia, and gender inequality) influence and are influenced by institutional environments (laws, regulations, and policies that may affect civil and political rights). 
  • Laws, regulations, and policies affect conditions and opportunities where people live related to economics, social relationships, available services, and the physical environment. 
  • People’s living environments affect health outcomes across the cancer continuum, from prevention to mortality.

As part of our research, we seek to develop and use innovative methods to better disentangle the complex associations between social determinants of health and cancer disparities and provide evidence that can be used to mitigate these unjust differences.”

Farhad Islami, MD, PhD

Senior Scientific Director

Cancer Disparity Research

Our Work

Report on the Status of Cancer Disparities

Since 2021, the American Cancer Society (ACS) has published a biennial report about the status of cancer disparities in the United States in CA: A Cancer Journal for Clinician. The report provides updated data on disparities about the:

  • Risk factors and incidence of cancer
  • Early detection and stage of cancer at diagnosis
  • Treatment and survival after a cancer diagnosis
  • Mortality resulting from cancer
  • Sociodemographic factors that contribute to cancer disparities across the cancer care continuum, including:
    • Geographic location
    • Race/Ethnicity
    • Socioeconomic status

The report also reviews ACS and other programs (such as those recommended by the Centers for Disease Control and Prevention) that have reduced cancer disparities and provides recommendations to further mitigate these inequalities to policymakers at all levels of government (federal, state, and local). 

Socioeconomic Factors and 
Cancer Disparities 

Socioeconomic factors such as education, employment, health insurance status, housing, and income have the potential to contribute to significant disparities across the cancer continuum.

For example, people with limited income or inadequate health insurance coverage often face many hurdles when it comes to receiving cancer screening exams and high-quality cancer care, from the direct costs of medical services to indirect costs related to transportation, lost wages, caretaking expenses, and other needs.

Anytime a hurdle trips up their care—causing them to skip medications, or delay care, for instance—the risk for negative health outcomes increases and the disparities between them and people who do not face those hurdles increase.

Our Research Focus

The ACS Cancer Disparity Research team leads studies to better understand the socioeconomic factors that shape cancer inequities as well as approaches for reducing those inequities.

Our current research focuses on:

  • The effect health insurance status has on cancer screening, risk of being diagnosed with cancer at advanced stages, and other cancer-related health outcomes
  • How access to affordable housing programs affects participation in cancer screening and access to cancer care among people with limited income
  • How access to education affects disparities in cancer incidence and mortality
  • The impact of COVID-19 on socioeconomic disparities in cancer-related care and outcomes after that care.

Social and Community Context and Cancer Disparities

Social and Community Context refers to the settings, social relationships, and connections between people and institutions where people live, work, and play. The phrase includes issues including civic participation, discrimination, conditions in the workplace, and incarceration—all of which can affect health outcomes in numerous ways.

Social relationships, for instance, influence health-related norms (including values, beliefs, attitudes, and behaviors), shape access to relationship networks (social capital) and other health-promoting resources, and impact how we cope with stress.

Furthermore, structural inequalities (such as differences in how many hospitals are in an area or safe neighborhoods to play and exercise in as well as economic segregation) and social injustice (such as racism, homophobia, and gender inequality) can affect the social interactions and connections in a community in ways that may either support or undermine the health of the people who live there.

For example, access to robust social, emotional, and material support systems can help influence people’s participation in cancer screening and help cancer patients navigate complex diagnoses and manage challenging treatment regimens.

Our Research Focus

The ACS Cancer Disparity Research team analyzes how social and community relationships and structures contribute to cancer disparities by race/ethnicity, age, gender, and other sociodemographic characteristics. Some of our current research examines:

  • How residential stability, living arrangements, and social support affect participation in cancer screening and the occurrence of cancer
  • The effects of loneliness, self-reported pain, and fatigue have on quality of life among cancer survivors
  • The effects of neighborhood disorder and social cohesion have on physical and mental health status as well as other health outcomes among cancer survivors
  • How living alone affects cancer mortality and other cancer-related outcomes among cancer survivors

Neighborhood/Built Environment and Health Disparities 

There’s a common refrain in health research: ‘Tell me your ZIP code, and I will know your health.’ The declaration is based on the spatial pattern of social determinants of health demonstrating how our exposure to disease risk factors and our access to quality care are shaped by where we live.

Some important social determinants of health are embedded in the built environment (the physical structures and spaces, like parks) of a neighborhood. The unique set of characteristics for a neighborhood influence health outcomes which may result in geographic health disparities.

Our Research Focus

The ACS Cancer Disparity Research team engages in research that examines how neighborhood conditions and features of the built environment relate to cancer disparities, including accessibility to cancer screening and care, access to healthy foods, and accessibility to areas for being physically active.

Accessibility to cancer screening and care

Although cancer screening is widely available in the United States, the geographic variations in accessibility to screening facilities leads to substantial disparities in the utilization of screening.. Similar geographic variations in the location of specialty providers and devices cause disparities in accessibility to cancer treatment. The ACS Cancer Disparity Research team examines these disparities between different geographic locations and between urban and rural areas.

Access to healthy food

Limited access to healthy food is a potential contributor to several adverse health conditions, including diabetes and obesity. Our team examines how the neighborhood food environment allows for access to healthy grocery stores and to better understand their relationship to health and outcomes across the cancer continuum.

Greenspaces and walkability

Built environments, including roads, housing, parks, sidewalks, and greenspace, potentially provide a place for physical activity, which can affect overall health, risk of developing cancer, and outcomes of cancer screening and treatment. Our team is seeking to understand associations between changes in neighborhood greenspaces and walkability on residents’ health, including obesity prevalence and cancer-related outcomes.

Residential Mobility and Health Disparities

Residence in historically disadvantaged neighborhoods (such as those adversely affected by historical mortgage lending bias known as redlining) has been linked to adverse health outcomes. However, urban renewal/rebuilding initiatives, mobility of residential populations, and gentrification (changes in a neighborhood through the influx of more affluent residents and investment) can change the environmental and socio-demographic characteristics in these neighborhoods, and consequently, affect population health.

Our Research Focus

The ACS Cancer Disparity Research team evaluates the role of residential mobility patterns and changes in neighborhood demographics have on disparities in health outcomes. Our team evaluates how the link between gentrification and life expectancy and cancer-related outcomes can be explained by population mobility and the influx of wealthy residents. 

How Potentially Modifiable Risk Factors Affect Cancer Incidence and Mortality  

Contemporary information on the portion of cancers that could potentially be prevented is useful for setting priorities for cancer prevention and control programs.

Our Research Focus

Researchers at the ACS Cancer Disparity Research team estimate the proportion and number of cancer cases and deaths in the United States, nationally and at the state level (overall and by specific cancer type) that are attributable to major, potentially modifiable factors that can cause cancer. These modifiable risk factors include:

  • Smoking cigarettes
  • Being exposed to secondhand smoke
  • Overweight and obesity
  • Drinking alcohol
  • Eating red or processed meat, or both
  • Not eating the recommended daily servings of fruits and vegetables
  • Not consuming foods with the recommended amounts of dietary fiber and calcium
  • Not taking part in the recommended amount of physical activity
  • Exposing yourself to too much ultraviolet radiation, such as from excessive sun exposure and indoor tanning
  • Not taking precautionary measures to protect against cancer-associated infections

The ACS Cancer Disparities Research Team

These cancer disparities researchers are part of the larger ACS Surveillance and Health Equity Science department:

Farhad Islami, MD, PhD, Senior Scientific Director

Daniel Wiese, PhD, Principal Scientist

Parichoy Pal Choudhury, PhD, Principal Scientist 

Hyunjung Lee, PhD, Principal Scientist

Jordan Baeker Bispo, PhD, Principal Scientist

Dongjun Lee, MS, Associate Scientist II