Racial Gap in Cancer Deaths Continues to Narrow

Black women still more likely to die from breast cancer, black men from colon cancer

The gap in cancer deaths in the United States has narrowed for most cancers, but disparities remain for two common cancers, according to a recent report from the American Cancer Society.

For deaths from breast cancer in women, the gulf between blacks and whites has widened. For deaths from colon cancer in men, the racial divide has remained steady at 50 percent higher for blacks than whites. This imbalance, researchers said, is likely driven by inequalities in access to care, screening and treatment.

“There is good news. Cancer death rates among black women are decreasing for all of the top cancers, but compared to whites not as much progress has been made—particularly for breast cancer,” said lead researcher Carol DeSantis, an epidemiologist with ACS.

Fewer overall cancer deaths since the early 1990s have saved more than 300,000 black lives over the past two decades, the report noted, suggesting that deaths are declining because improved screening detects many cancers earlier, and improvements in care have made treatments more effective.

“The disparities remain because not everyone is getting access to the best cancer therapies,” DeSantis said. She also blamed the disparity in care on economics not race. “It’s just that there are more poor blacks,” she said.

The report, published in CA: A Cancer Journal for Clinicians, highlighted other findings:

• Cancer death rates have dropped faster among blacks than whites for all cancers combined, and for lung, prostate and colon cancer in women.
• In 1990, the cancer death rate for men was 47 percent higher in blacks than in whites; in 2012 it dropped to 24 percent higher. Among women, the disparity decreased from 19 percent higher in 1991 to 14 percent in 2012.
• Since 1990, deaths from breast cancer dropped 23 percent among black women and 37 percent among white women, increasing the racial disparity. From 2008 to 2012, breast cancer deaths were 42 percent higher in black women than in white women, despite lower breast cancer rates overall. Researchers said the higher death rates among black women are likely due to a number of factors, including differences in cancer progression at diagnosis, obesity, other chronic illnesses, tumor type and access to care.
• From 2003 to 2012, colon cancer deaths dropped faster among black women than white women. But the drop was slower among black men than white men.
• For most cancers, fewer blacks than whites survive five years. Researchers suggested much of this difference is due to limited access to “timely, appropriate and high-quality care.” These barriers result in later diagnosis, when treatment choices are limited and often less effective.
• Obesity increases cancer risk, and black women have the highest obesity rates of any group. In 2013-2014, nearly six in 10 black women were obese, compared with about four in 10 white women. Obesity rates are similar in black and white men.

“There is some promising news that there is a narrowing of the gap in cancer disparities,” said Christopher Flowers, M.D., chair of the Health Disparities Committee for the American Society of Clinical Oncology. “But [this study] also raises the concern that there still is a gap between black and white patients in terms of cancer deaths.”

ASCO is trying to develop new ways to educate doctors and improve the quality of care in hospitals that “serve traditionally underserved populations,” Dr. Flowers said, adding that Medicaid reform might help to address the racial disparities in cancer care.

DeSantis said changes in insurance access, through the Affordable Care Act, will likely help narrow the gap between blacks and whites, because more people will have health insurance. “That’s a huge step,” she said.