The American Cancer Society (ACS) recently reported that the number of Americans who died from cancer has declined for a second year in a row. Hidden within this good news is the troubling fact that African Americans are still 21 percent more likely to die from cancer than white Americans -- the highest cancer death rate of any racial or ethnic group. Memorial Sloan-Kettering is working to help address this and other racial and ethnic disparities in cancer outcomes through its Office of Diversity Programs in Clinical Care, Research, and Training.
Statistical Disparities
Although the racial disparity for cancer death rates has decreased over the last ten years, a new report released by the ACS noted that the death rate for African Americans continues to be 35 percent higher for black American men and 18 percent higher for black American women than for white American men and women. The report, Cancer Facts & Figures for African Americans 2007-2008, stated that 153,000 of the 1.4 million total new cases of invasive cancer in 2007 in the US will be diagnosed in black Americans. Of the 560,000 estimated cancer deaths in the country in 2007, the ACS estimates that 63,000 of them will be among African Americans, with lung, breast, prostate, and colorectal cancers as the leading causes of death.
As an example of these statistical disparities, the US Department of Health and Human Services reports that in 2003 African American women were 36 percent more likely to die from breast cancer than non-Hispanic white women. Similarly, also in 2003, African American men were 2.4 times as likely to die from prostate cancer compared to non-Hispanic white men. (Black Americans also suffer higher rates of other major diseases, such as heart disease and diabetes.)
Five-year survival rates are a good measuring stick for gauging progress in the early detection and treatment of cancer. According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, the overall five-year cancer survival rate has improved for black Americans from about 27 percent during the years 1960-1963 to 57 percent during the years 1996-2002. However, African Americans as a group are still less likely to survive five years after diagnosis from all types of cancer and all stages of diagnosis than other racial and ethnic groups.
"Although we are encouraged by the overall decrease in cancer deaths in the United States, the results of the ACS report remind us that for African-Americans disparities in survival from cancer are still significant," says Carol Brown, MD, Director of the Office of Diversity Programs in Clinical Care, Research, and Training. "Finding ways to reduce and eliminate these types of cancer health disparities is central to our mission at Memorial Sloan-Kettering."
Underlying Causes
What are the causes of these disparities? Interestingly, the ACS report notes that race- and ethnicity-associated biological and inherited predispositions are only negligibly responsible for the differences. Instead, the report's authors suggest that lingering disparities in work, wealth, income, and education play a greater role. While recent advances in prevention, screening, and treatment have aided American society as a whole, economic and social barriers continue to exist, serving to separate some African Americans from these resources. Using the five-year survival statistics as an example, experts believe that the difference in cancer survival rates is the result of African Americans, on average, receiving diagnoses at a later stage, when the disease has spread, or metastasized, to other parts of the body, making it more difficult to treat.
In general, as the ACS report notes, socioeconomic factors independent of race and ethnic class are believed to play a large role, influencing everything from prevention and early detection to treatment, quality of life, and survival. As a proportion of the overall population, poor and uninsured individuals are more likely to smoke, less likely to engage in exercise leading to a healthy body weight, and are less likely to have access to regular high-quality screening tests and appropriate follow-up care.
Working Towards a Solution
To begin to combat these disparities, Memorial Sloan-Kettering, through its Office of Diversity Programs, is working to improve the screening, diagnosis, and treatment of cancer in underserved communities through our community outreach collaborators -- Ralph Lauren Center for Cancer Care and Prevention (RLCCCP) -- a partnership between Memorial Sloan-Kettering and Harlem's North General Hospital -- and Memorial Sloan-Kettering 's Breast Examination Center of Harlem (BECH).
Memorial Sloan-Kettering has also recently teamed with the ACS, the Queens Public Library, and the Queens Cancer Center of Queens Hospital to create the Queens Library HealthLink initiative. This initiative places libraries at the center of an innovative new effort designed to help medically underserved communities throughout Queens access free cancer information, early detection screenings, cancer treatment resources, and other life-saving services.
It is hoped that these and other measures will begin to erase the disparities between cancer incidence and survival.
