A new study by the American Cancer Society reveals that Black people are significantly more likely to die from certain types of cancer, owing to structural inequities in access to both health care and information.
As part of the organization’s yearly cancer statistics, published in the peer-reviewed medical journal “CA: A Cancer Journal for Clinicians,” the study found that prostate cancer mortality rates in Black men are about two to four times higher than those in every other racial and ethnic group. Additionally, Black women are more likely than those in other ethnic groups to die from breast and uterine cancer.
“The biggest impact is lack of access to diagnostics, to prevention, to treatments,” Larry Norton, a medical oncologist and senior vice president at Memorial Sloan Kettering Cancer Center and medical director of the Evelyn H. Lauder Breast Center, told Yahoo News. “That's clearly the biggest gap, and that's something that has to be addressed. Lack of access is partially just lack of penetration of information.”
The scope of cancer diagnoses is vast. The new study projects that there will be about 1,958,310 new U.S. cancer cases this year. Of that number, about 609,820 people are expected to die from cancer. Lung cancer is projected to be the leading type of cancer death for both men and women, followed by prostate and colorectal cancer in men and breast and colorectal cancer in women.
Racial disparities exist in both the incidence of various cancers and mortality rates. The highest mortality rate for both sexes combined is among American Indian/Alaska Natives (AIAN), with the rate among Black people coming in a close second.
The overall incidence of cancer — defined by the National Cancer Institute as “the number of new cancers of a specific site/type occurring in a specified population during a year” — is highest among white people, with AIAN and Black people closely following them. The study found, however, that sex-specific incidence is highest among Black men. From 2015 to 2019, the rate for Black men was 79% higher than for Asian American and Pacific Islander (AAPI) men, who have the lowest incidence rates, and 5% higher than for white men, who are ranked second.
Although prostate cancer mortality has dropped by 53% since its peak 30 years ago — largely thanks to early detection through widespread screening and advances in treatment — the incidence of cancer of the prostate is particularly high among Black men. Prostate cancer is 70% higher in Black men than in white men, two times higher than in AIAN and Hispanic men, and three times higher than in AAPI men. Cancer screening is potentially more beneficial for Black men, the study says, because they are more likely to contract “genomically aggressive cancer.”
“It's not well understood why, but Black men can be diagnosed with a prostate cancer that looks to be not very aggressive, the same type as in a white man,” Rebecca Siegel, the senior scientific director of surveillance research at the American Cancer Society and one of the study’s authors, told Yahoo News. “But then, for some unknown reason, the same cancer in a Black man will go on to cause death, and it's not understood why that is. So that's why Black men benefit more from screening and need to have those screening conversations earlier.”
Siegel recommends that all men start having a conversation with their primary care provider at age 50 about the benefits and harms of prostate-specific antigen (PSA) testing, with a discussion of the individual risk.
“If you're a man that has a family history of prostate cancer, then you would want to start thinking about this earlier,” Siegel said. “In fact, we recommend that Black men, because they have such high rates of prostate cancer, begin this conversation with their health care provider at age 45.”
She added, “And then if you don't have a family history or you're another racial or ethnic group, then [you should start] the conversation at 50 and just [make] the right decision for you.”
AIAN and Black women have the highest mortality rates from cancer — 16% and 12% higher, respectively, than white women. Although Black women have a 4% lower incidence of breast cancer than white women, their breast cancer mortality is 40% higher.
“Of course, women who have a family history of breast cancer should begin talking with their health care providers at a young age about screening,” Siegel said. “In general, women who are at average risk should have the opportunity to begin screening at 40. But we urge women to begin regular screening, annual screening, at age 45.”
The Cancer Society study notes the dearth of major treatment advances for women with uterine corpus cancer, often called endometrial cancer. The survival rate for this type of cancer has not improved over the past four decades. The lack of research activity has disproportionately affected Black women, who are substantially less likely to be diagnosed than white women and who have a lower survival rate. According to the study, endometrial cancer is the fourth most commonly diagnosed cancer in women, but Siegel says it ranks 24th in National Cancer Institute funding.
“Black and white women have about the same incidence of uterine cancer,” Siegel said. “But Black women are twice as likely to die. It's partly because Black women are diagnosed with a more aggressive subtype. It's called non-endometrioid, and Black women are more than twice as likely to be diagnosed with this subtype.”
The disparities in survival are stark, Siegel said. “Overall survival for white women is 84% — 84% of white women will be alive at five years after diagnosis, compared to 64% of Black women. That’s just not acceptable.”
The study attributes the impact of cancer mortality in the Black community to racial disparities, saying it is “largely a consequence of less access to high-quality care across the cancer continuum.”
“Racial disparities in cancer occurrence and outcomes are largely the result of long-standing inequalities in wealth that lead to differences in both risk factor exposures and access to equitable cancer prevention, early detection, and treatment,” the report says.
"Ultimately, disproportionate wealth stems from hundreds of years of structural racism, including segregationist and discriminatory policies in criminal justice, housing, education, and employment that have altered the balance of prosperity, security, and other social determinants of health."
According to the World Health Organization, the social determinants of health are defined as the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. For example, factors like housing, basic amenities, environment, access to affordable health care services, food security and income can be linked to life expectancy and mortality from disease.
“One of the major determinants of how long you're going to live are factors like what your ZIP code is, or your transportation,” Norton said. “Those are what are called social determinants of health. We have to specifically make sure that our health care systems are available to everybody, geographically and economically.”
Survival rates are lower for Black patients than for white patients for every type of cancer except pancreas and kidney cancer, for which the rates are similar. Black people have lower stage-specific survival for most cancer types, and the risk of death from cancer is 33% higher in Black people and 51% higher in AIAN people compared with white people.
Norton points to biological determinants, which can be a critically important factor in explaining why survival and death rates may be higher among certain races and ethnic groups.
“You take somebody whose ancestry evolved in a place where there wasn't very much sunlight. And so they needed light skin to be able to make vitamin D.” Norton added. “And then you put them in an equatorial place where there's sunlight all the time. I mean, they're going to be prone to a disease, which is skin cancer. So those are the kinds of things that we need to explore and we need to address.”
COVID-19 also played a role in cancer diagnoses. Routine mammography screenings, for example, were halted during the early stages of the pandemic and have been slower to rebound among people of color. Data from sources like the National Cancer Institute also shows that the pandemic disproportionately affected people of color in the United States. Black, AIAN and Hispanic people had two times the rate of overall excess deaths in 2020 compared with white people and had two to four times the rate of non-COVID-related excess deaths.
“The biggest impact of COVID is decreased screening,” Norton said. “People were afraid to come to hospitals, afraid to come to centers to get screened for cancer. So we've seen a big drop in screening. We are going to see for many years an increase in advanced cancers because of that lack of screening. We're not back up to, for the most part as a nation, we're not back up to where we were before, pre-COVID. People stopped doing their mammograms and stopped doing their colonoscopies, and they haven't gone back.”
But the study emphasizes that COVID’s impact on cancer mortality rates “will continue to unfold over many years and will likely parallel the disproportionate COVID-19 burden in the United States compared with other countries.”
“We've been reporting on these cancer disparities for many, many years, so these disparities are not due to COVID,” Siegel said. “It's likely that we will see, down the road, maybe a widening in these disparities because of COVID. The impact of COVID on cancer is going to take time, because how that will likely play out is that there was a disruption in health care that may result in later-stage cancer diagnosis and then, ultimately, a higher mortality. But that's all going to take many years to realize.”
The Cancer Society study highlighted some encouraging statistical news on prevention and treatment, especially in women’s reproductive health.
“There was a steep drop-off in cervical cancer incidence in women in their early 20s,” Siegel said. “The reason that's so exciting is because these women are the first group who were exposed to the HPV vaccine, which was introduced in the U.S. in 2006. So this is real population-based evidence of the effectiveness of the vaccine. We found a 65% drop in cervical cancer incidence from 2012 to 2019 in these women in their early 20s, and we found a similar drop in Black, Hispanic and white women. So the vaccine is working, and this is probably the tip of the iceberg.”