Black Americans have the highest overall cancer death rates in the United States, a pattern that holds for both men and women. Between 2018 and 2020, Black men died from cancer at a rate of about 298 per 100,000, compared with roughly 251 for white men, while Black women died at about 207 per 100,000, compared with 183 for white women. But that top-line answer obscures enormous variation by cancer type, geography, and subpopulation. For certain cancers, other groups bear a heavier burden, and the reasons behind any group’s elevated risk involve a tangle of access to care, environmental exposures, poverty, and biology that no single statistic can capture.
The Overall Mortality Numbers
A study published in the Journal of the National Cancer Institute analyzed U.S. cancer death rates from 2018 to 2020, broken down by race and ethnicity. Among men, the ranking ran from Black men at the top (298.2 deaths per 100,000) down through white men (250.8), American Indian and Alaska Native men (249.2), Native Hawaiian and Pacific Islander men (205.6), Latino men (177.2), and Asian men (147.9). Among women, Black women again led (206.5), followed by Native Hawaiian and Pacific Islander women (192.1), American Indian and Alaska Native women (189.9), white women (183.0), Latina women (128.4), and Asian women (111.4).1PubMed Central. Cancer mortality rates by racial and ethnic groups in the United States, 2018-2020 The gap between the highest and lowest groups is striking: Black men die from cancer at roughly twice the rate of Asian men.
These numbers describe mortality, not incidence. A group can have moderate rates of getting diagnosed with cancer yet high rates of dying from it if treatment comes late, is lower quality, or the cancers tend to be diagnosed at more advanced stages. That distinction matters for every comparison that follows.
How the Picture Shifts by Cancer Type
Overall rankings collapse dozens of different diseases into one number. When you zoom into individual cancers, the group at highest risk often changes.
Prostate Cancer
Black men are disproportionately affected by prostate cancer, presenting earlier, with more aggressive disease, and with higher mortality than white men.2PubMed Central. Racial disparities in Black men with prostate cancer: A literature review Prostate cancer is the single largest contributor to the overall cancer mortality gap between Black and white men. Researchers have debated for years how much of this reflects biology versus barriers to early detection, and the honest answer is both. There are measurable differences in tumor biology, but delayed screening and treatment access widen the gap further.
Breast Cancer
White women are actually slightly more likely to be diagnosed with breast cancer overall, but Black women are more likely to die from it. A major reason is the disproportionate burden of triple-negative breast cancer (TNBC), an aggressive subtype that lacks the hormone receptors targeted by many standard therapies. Across 38 states, Black women had TNBC incidence rates of about 25 per 100,000, roughly double the rate in white women (about 13 per 100,000).3PubMed Central. State Variation in Racial and Ethnic Disparities in Incidence of Triple-Negative Breast Cancer Among US Women In some states the disparity is even wider: Black women in Delaware had TNBC rates exceeding 32 per 100,000.
Whether this disparity is driven by distinct molecular biology or by the downstream effects of poverty and poorer healthcare remains genuinely contested. A review in Nature Reviews Cancer noted evidence supporting both explanations and concluded the question is unresolved.4PubMed Central. Triple-negative breast cancer in African-American women: disparities versus biology Research comparing African-American and white women with TNBC found that the frequency of TNBC among all breast cancers was more than twice as high in African-American women (28% versus 12%), though significant survival and pathological differences between the two groups were not detected after adjusting for other factors.5PubMed Central. Outcome disparities in African American women with triple negative breast cancer: a comparison of epidemiological and molecular factors between African American and Caucasian women with triple negative breast cancer
Stomach Cancer
Stomach cancer tells a completely different story. Here, several Asian subgroups and Hispanic populations bear a heavier burden than either Black or white Americans. In California data from 2011 to 2015, the highest stomach cancer incidence appeared among foreign-born Korean American and Japanese American men, at roughly 32 to 33 per 100,000, about four times the rate in non-Hispanic white men.6PubMed Central. Population-based evaluation of disparities in stomach cancer by nativity among Asian and Hispanic populations in California, 2011–2015 Nationally, stomach cancer mortality in 2019 was highest among Black Americans at about 6.8 deaths per 100,000, followed by American Indian/Alaska Native, Latino, and Asian populations, with white Americans lowest at 3.5.7The Lancet Regional Health – Americas. The burden of stomach cancer mortality by county, race, and ethnicity in the USA, 2000–2019 The role of H. pylori infection, dietary patterns, and nativity make stomach cancer one of the clearest examples of how environment and migration history shape risk.
Colorectal Cancer
Black Americans have the highest colorectal cancer incidence and mortality in the U.S.8PubMed Central. Racial and ethnic disparities in colorectal cancer incidence and mortality American Indian and Alaska Native populations also face a disproportionate burden.9PubMed. Racial and Ethnic Disparities in Colorectal Cancer Screening and Outcomes An emerging concern is early-onset colorectal cancer in adults younger than 50. Trend data show that white Americans are the only group with a consistent incidence increase across all younger age categories, though Black Americans still have the highest incidence at every age.10PubMed Central. Trends in Early-onset vs Late-onset Colorectal Cancer Incidence by Race/Ethnicity in the United States Cancer Statistics Database
Liver Cancer
Liver cancer risk is sharply stratified by Asian subgroup. Hepatitis B-related liver cancer rates remained persistently high through 2019 in several Asian American subpopulations. Laotian American men had the highest rates, at about 25 per 100,000, followed by Cambodian, Vietnamese, Korean, and Chinese American men with rates ranging from roughly 10 to 18 per 100,000.11JAMA Network Open. Liver Cancer Etiology in Asian Subgroups and American Indian, Black, Latino, and White Populations Lumping all Asian Americans together in cancer statistics hides the fact that some subgroups face liver cancer rates many times higher than the national average.
Lung Cancer in Never-Smokers
Lung cancer is usually associated with smoking, but among people who have never smoked, the racial pattern flips in surprising ways. Asian and Pacific Islander women have some of the highest rates of lung cancer among never-smokers, and among Asian/Pacific Islander women, lung cancer in never-smokers was the second leading cause of cancer death, trailing only breast cancer.12PubMed. Lung cancer in never smokers: Distinct population-based patterns by age, sex, and race/ethnicity Separately, a large multiethnic study found that at the same level of cigarette consumption (up to 30 per day), Black Americans and Native Hawaiians had substantially greater lung cancer risk than white, Japanese American, or Latino smokers. Those differences disappeared only at the heaviest levels of smoking.13PubMed. Ethnic and racial differences in the smoking-related risk of lung cancer The reasons are not fully understood, but they point to differences in how the body metabolizes tobacco carcinogens.
Why Lumping Groups Together Distorts the Numbers
Federal cancer registries historically record race in broad categories. “Asian” covers dozens of nationalities with wildly different risk profiles. Disaggregated data make this clear. For colorectal cancer mortality, Asian Indian Americans had the lowest rate among Asian subgroups, at about a third the rate of non-Hispanic white Americans, while Japanese Americans had rates approaching parity with white Americans. Korean and Vietnamese Americans saw their colorectal cancer mortality increase over the study period from 2005 to 2020, and by the end of that window Korean Americans had the highest colorectal cancer mortality of any Asian subgroup.14PubMed Central. Disaggregated Colorectal Cancer Mortality among Asian American Subgroups between 2005 and 2020 Reporting a single “Asian” cancer rate averages these very different realities into a number that is accurate for no one.
A parallel problem exists for American Indian and Alaska Native populations, where racial misclassification on death certificates artificially lowers the recorded cancer burden. A study using Indian Health Service data found that in counties without large Native populations, sensitivity for correctly identifying American Indian/Alaska Native individuals on vital records was as low as 28 to 55%, meaning a large share of Native cancer deaths were simply counted under a different racial category.15PubMed Central. Racial Misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area When analyses are restricted to areas where classification is more reliable, the picture worsens. Overall cancer incidence among American Indian and Alaska Native people was about 2% higher than among white people, but mortality was 18% higher, with wide variation by cancer type and region.16PubMed. Cancer statistics for American Indian and Alaska Native individuals, 2022
Poverty, Insurance, and Treatment Gaps
Socioeconomic status is one of the most powerful predictors of cancer death, and it overlaps heavily with race in the United States. Residents of the poorest U.S. counties have 13% higher cancer death rates among men and 3% higher rates among women compared with the most affluent counties. Five-year survival for all cancers combined is 10 percentage points lower among people living in poorer census tracts. Even after accounting for poverty, Black, American Indian/Alaska Native, and Asian/Pacific Islander men still have lower survival than white men, suggesting that poverty alone does not explain the full gap.17PubMed. Cancer disparities by race/ethnicity and socioeconomic status
A systematic review and meta-analysis quantified how much of the Black-white mortality gap can be attributed to socioeconomic status. Adjusting for income, education, and related factors reduced the elevated cancer mortality risk in Black adults compared with white adults by about 19%, from a hazard ratio of 1.35 down to 1.16. That is a meaningful reduction, but the residual gap remained statistically significant. Interestingly, the lower cancer mortality observed among Asian Americans persisted even after adjusting for socioeconomic status, suggesting protective factors independent of income.18PubMed. Race and Ethnicity Disparities in Cardiovascular and Cancer Mortality: the Role of Socioeconomic Status
Within the healthcare system itself, disparities persist even among people with the same type of insurance. A study of breast cancer hospitalizations found that Black patients were less likely to receive mastectomies and more likely to experience post-surgical complications and in-hospital death compared with white patients, and these associations were actually strongest among women with private insurance.19PubMed Central. Racial and Socio-Economic Disparities in Breast Cancer Hospitalization Outcomes by Insurance Status Having good insurance, in other words, did not erase the disparity.
Rural residence compounds these issues. A scoping review found that racial and ethnic minorities in rural areas were more likely to have low cancer-related knowledge, lower screening rates, less access to treatment, and higher mortality compared with their white counterparts in similar settings.20PubMed Central. Racial and Ethnic Disparities in Cancer Occurrence and Outcomes in Rural United States: A Scoping Review
Genetics Versus Social Conditions
A common assumption is that racial differences in cancer must be substantially genetic. The evidence, at least so far, points more strongly toward social and environmental explanations. A 2025 study in JAMA Network Open examined whether African genetic ancestry was associated with higher mortality among Black adults after controlling for structural and social determinants of health. It found that African genetic ancestry had no meaningful association with all-cause mortality once factors like neighborhood socioeconomic status and income were accounted for. Income-based measures, by contrast, remained strongly associated with mortality.21PubMed Central. African Genetic Ancestry, Structural and Social Determinants of Health, and Mortality in Black Adults
That does not mean genetics plays zero role. For breast cancer specifically, African genetic ancestry does appear to be associated with a higher likelihood of aggressive tumor subtypes like TNBC. But a study of Black breast cancer survivors found that social environments and healthcare access were more important for survival than genetic ancestry. Genetic ancestry could help predict which tumors would be aggressive, but what happened after diagnosis depended far more on where a woman lived and what care she could access.22Rutgers Cancer Institute of New Jersey. Genetic Ancestry and Social Environment may Influence How Aggressive Breast Cancer is in Black Women A broader review of the field concluded that while quantified genetic ancestry is expanding our understanding of cancer biology across racial groups, studying biological determinants in isolation from social determinants will not improve outcomes.23PubMed. Understanding how genetic ancestry may influence cancer development
What Migration Studies Reveal
Some of the most compelling evidence for the role of environment comes from studies of immigrants. When people move from a low-risk country to a high-risk one (or vice versa), their cancer rates tend to shift toward those of their new home over time. A Swedish study found that immigrants’ risks of colorectal, lung, breast, and prostate cancers moved toward native Swedish rates depending on sex, age at immigration, and duration of residence, pointing to a major role for environmental exposures.24PubMed. Age- and time-dependent changes in cancer incidence among immigrants to Sweden
Canadian data show a similar pattern. Immigrants to Canada generally have lower cancer rates than the Canadian-born population, a phenomenon researchers call the healthy immigrant effect. But immigrants from the United States and Europe did not show this advantage, likely because they arrived with environmental and lifestyle exposures similar to those in Canada. Over time, the cancer rates of other immigrant groups converged with those of the Canadian-born as well.25PubMed Central. Population-based differences in cancer incidence between immigrants and non-immigrants in Canada between 1992 and 2015
Not every cancer follows this acculturation pattern neatly. Middle Eastern immigrants to California maintained elevated risks of breast, thyroid, and bladder cancers relative to non-Hispanic white Californians regardless of how long they had lived in the U.S., suggesting some combination of genetic predisposition and persistent cultural factors. But for most other cancers, second-generation Middle Eastern Americans approached the risk levels of the general population.26PubMed Central. Cancer risk in different generations of Middle Eastern immigrants to California, 1988-2013
The Clinical Trial Gap
One underappreciated reason cancer disparities persist is that the treatments we develop and test are overwhelmingly studied in white patients. White participants have been consistently overrepresented in U.S. oncology clinical trials, while Black and Asian patients have been underrepresented, and Native Americans have had consistently poor or no representation at all.27PubMed Central. Equitable inclusion of diverse populations in oncology clinical trials: deterrents and drivers More than two decades after Congress passed legislation intended to diversify clinical research, the proportion of minority patients enrolled in cancer trials remained stubbornly low.28PubMed Central. Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT)
This creates a circular problem. Treatments are tested primarily in white populations, so we have less confidence that the dosing, side effect profiles, and outcomes translate equally to other groups. Drugs metabolized differently across populations may be less effective or more toxic in groups that were barely included in the trials that led to their approval. And without that trial participation, the data gaps in understanding cancer in minority populations only widen.
Disparities That Start in Childhood
Cancer disparities are not limited to adults. Among children with high-risk neuroblastoma, a serious childhood cancer, Black and Hispanic children had worse overall survival than white children, even when all groups received the same planned treatment through Children’s Oncology Group clinical trials. The differences were especially pronounced in the post-consolidation phase of treatment, meaning the disparities showed up even after the initial aggressive therapy was identical. Race and ethnicity remained independently associated with survival after adjusting for disease characteristics.29JAMA Network Open. Racial and Ethnic Survival Disparities Among Children With High-Risk Neuroblastoma That finding is sobering because it rules out the most obvious explanation, that minority children simply receive worse initial treatment. Something else, whether supportive care, follow-up adherence, social stressors on families, or unmeasured biological factors, is contributing to worse outcomes even within the controlled setting of a clinical trial.
Environmental Exposure and Where People Live
Where you live affects what you breathe, drink, and absorb, and residential patterns in the United States are not racially neutral. A scoping review of environmental cancer risk found that neighborhoods with higher proportions of low-income residents and racialized populations had higher exposures to carcinogens and environments that may increase cancer risk.30PubMed Central. Inequalities in Environmental Cancer Risk and Carcinogen Exposures: A Scoping Review Industrial facilities, hazardous waste sites, and polluted air are disproportionately concentrated near communities of color, a pattern documented for decades under the framework of environmental justice. These exposures contribute to cancer risk in ways that no amount of individual behavior change can fully offset.
Cervical cancer screening follow-up offers another example of how geography and system-level barriers interact with race. A study of follow-up adherence after abnormal cervical cancer screening found that about 46% of Black patients did not adhere to recommended follow-up, compared with 39% of white patients and 29% of Latina patients. Black and Latina patients were also more commonly delayed in returning for their follow-up appointments.31PubMed Central. Increased disparities associated with black women and abnormal cervical cancer screening follow-up These are not differences in biology. They reflect transportation barriers, clinic availability, work schedules, and the accumulated friction of navigating a healthcare system that was not designed with equal access in mind.