The landscape of cancer incidence and outcomes is complex, influenced by a multitude of interconnected factors that extend beyond simple biological predispositions. While statistics may show varying rates among different racial and ethnic groups, it is important to recognize that “race” itself is largely a social construct. Disparities in cancer are not due to inherent biological differences between races, but rather reflect the profound impact of social, environmental, and systemic factors that shape health experiences and outcomes. Understanding these nuances is the first step toward addressing the inequities that exist in cancer care and prevention.
Understanding Cancer Disparities Among Racial and Ethnic Groups
Cancer incidence and mortality rates vary across different racial and ethnic groups in the United States. Black individuals, for example, have experienced higher overall cancer incidence and death rates. For men, Black men have the highest cancer death rates at 298.2 per 100,000, followed by White men at 250.8 per 100,000, and American Indian/Alaska Native (AI/AN) men at 249.2 per 100,000. Among women, Black women also have the highest cancer death rates at 206.5 per 100,000, followed by Native Hawaiian and Pacific Islander (NHPI) women at 192.1 per 100,000, and AI/AN women at 189.9 per 100,000.
Specific cancer types show more pronounced disparities. Black men have a prostate cancer incidence rate 67% higher than White men and are more than twice as likely to die from the disease. Black women face a 38% higher likelihood of dying from breast cancer compared to White women, despite a 5% lower incidence rate. Colorectal cancer incidence and mortality are highest in Black and American Indian/Alaskan Native patients, with Black individuals being about 20% more likely to develop and 40% more likely to die from it. Black patients also face significantly higher mortality risks for multiple myeloma, endometrial, stomach, cervical, and liver cancers.
Hispanic or Latino individuals have lower incidence and death rates for common cancers like breast, prostate, lung, and colorectal cancers compared to non-Hispanic White individuals. They experience higher incidence and mortality rates for stomach, liver, cervical, and gallbladder cancers. Cervical cancer incidence and death rates are 50% to 70% higher in Hispanic women compared to non-Hispanic White women, and Hispanic individuals also have high rates of liver cancer mortality.
Asian Americans have lower overall cancer rates than non-Hispanic White populations, but disparities exist for specific cancer types. Liver and stomach cancers occur at higher rates among Asian Americans, with Asian/Pacific Islander men having significantly higher incidence of liver and stomach cancers than non-Hispanic White men. Asian/Pacific Islander women are twice as likely to have stomach cancer compared to non-Hispanic White women. Lung cancer rates in Asian American “never smokers” are also much higher than in other groups.
Key Factors Contributing to Disparities
The observed disparities in cancer rates across racial and ethnic groups stem from a complex interplay of socioeconomic, healthcare access, lifestyle, environmental, and biological factors. These elements overlap and compound, creating systemic disadvantages for certain populations.
Socioeconomic factors play a significant role in influencing cancer risk and outcomes. Income, education level, and occupation directly affect access to healthy food, quality healthcare, and healthy environments. People with lower socioeconomic status are more likely to experience delays in diagnosis and receive inadequate treatment, leading to poorer outcomes. The disparities in overall cancer mortality by education level within each race are considerably larger than the Black-White disparities, emphasizing the significant impact of poverty.
Healthcare access and quality are intertwined with socioeconomic status and contribute to disparities. People of color are more likely to be uninsured and face barriers such as transportation difficulties, limited availability of healthcare providers, and a lack of culturally competent care. These barriers can lead to delayed cancer screenings and diagnoses, resulting in more advanced disease when treatment is less effective. Health insurance accounted for a significant portion of the differences in late-stage diagnoses between non-Hispanic Black and White patients, and for Hispanic patients compared to non-Hispanic Whites. Hospitals serving a high proportion of racial and ethnic minority groups are also less likely to have most core cancer-related services compared to other hospitals, affecting access to timely and appropriate care.
Lifestyle and environmental factors also contribute to these disparities. Differences in diet, physical activity, and exposure to environmental toxins disproportionately affect certain communities. For example, populations with limited access to healthy food options, often low-income communities, are more likely to experience diet-related health disparities.
Exposure to environmental carcinogens, such as air pollution, is higher in neighborhoods with a greater proportion of low-income residents and racialized populations. Higher levels of airborne pollutant particles have been linked to increased cancer risk, with these risks differing by race and ethnicity.
While race is a social construct, some biological and genetic factors can interact with social and environmental influences to affect cancer risk. For example, founder mutations in BRCA1 and BRCA2 genes have been reported in specific populations, including those of African and Ashkenazi Jewish ancestry. Common genetic variants at the 8q24 risk locus, more frequent in populations of African ancestry, may contribute to the higher incidence of prostate cancer in Black men. These genetic predispositions interact with environmental and social factors, and race itself is not a biological determinant of cancer but rather a marker for exposure to social and environmental risks.
Addressing and Reducing Cancer Disparities
Addressing and reducing cancer disparities requires a multi-faceted approach involving policy initiatives, community engagement, and ongoing research. These strategies aim to dismantle systemic barriers and foster equitable opportunities for cancer prevention, early detection, and treatment for all populations.
Policy initiatives play a role in improving healthcare access and quality for underserved communities. Programs like the National Breast and Cervical Cancer Early Detection Program provide screenings and diagnostic services to women with low incomes or who are uninsured. Expanding health insurance coverage and ensuring access to high-quality clinical care can help reduce disparities in late-stage diagnoses across various cancer types. Policies regulating tobacco products, promoting environmental justice, and addressing obesity and physical inactivity also contribute to reducing cancer risks.
Community engagement is an important tool for developing culturally sensitive health education and outreach programs. Organizations work to build trust between healthcare providers and local communities, offering cancer navigation services and adapting educational initiatives to meet specific needs. Collaborations between healthcare providers and community members ensure that interventions are relevant and effective, fostering a two-way relationship that improves understanding and addresses challenges. Programs like the Connecting Underrepresented Populations to Clinical Trials are increasing the enrollment of diverse racial and ethnic groups in clinical trials through culturally tailored education.
Ongoing research is essential to understanding the biological and social factors that influence disparities and to developing targeted interventions. Researchers are investigating how socioeconomic factors, environmental exposures, and genetic predispositions interact to affect cancer outcomes. This research informs the development of improved screening tests and updated guidelines for high-risk minority groups, ensuring that scientific advancements benefit everyone. Efforts are focused on diversifying genomic sequencing databases to improve precision medicine for historically underrepresented demographics.
Individual and community empowerment contribute to reducing disparities. Encouraging healthy lifestyles, promoting early detection through regular screenings, and advocating for equitable healthcare policies are important actions. This collective effort, from policy-makers and researchers to community leaders and individuals, is essential to achieve health equity and ensure everyone has a fair opportunity to prevent, detect, and survive cancer.