According to the American Cancer Society (ACS), significant strides have been made over the past several decades to reduce the racial disparity of African Americans shouldering a disproportionate brunt of the country’s cancer burden, although a disparity still remains.
Non‐Hispanic blacks comprise 13% of the total US population and are the second largest ethnic minority group in the nation (behind only Hispanics). African Americans have the highest death rate and lowest survival rate of any racial or ethnic group for most forms of cancer, in addition to other leading causes of death such as heart disease, stroke, and diabetes. A chief contributor of this disparity lies in socioeconomic (SES) status, which is strongly linked to race in the US. In 2017, 21% of African Americans were living below the poverty line, which more than doubled the percentage of whites in poverty (9%). Moreover, only 22% of black Americans had completed four years of college juxtaposed to 36% of whites. People with less socioeconomic means face a litany of barriers to high-quality health care, which includes inadequate insurance coverage.
Individuals with lower SES experience numerous barriers to high‐quality health care, including lack of adequate insurance coverage. These numbers are reflected in 2017 statistics, which showed that 11% of blacks were uninsured compared with 6% of whites. Individuals without health coverage incur an increased risk of being diagnosed with advanced cancer compared to those with insurance. Fortunately, several initiatives were aimed at mitigating the insurance disparity, such as the 2010 passage of the Patient Protection and Affordable Care Act (ACA) and subsequently, the expansion of Medicaid. These measures helped reduce the number of uninsured African Americans by one‐half, particularly among those with less financial means. However, coverage gains among black people are still the lowest of any racial group, as the ACS notes, “it remains to be seen whether insurance coverage alone will ultimately reduce cancer disparities.”
Furthermore, the five-year survival rate is lower among blacks than whites for every stage of diagnosis and for most cancer sites, as well as for most cancer types. This can be attributed to having less access to health care plans or treatment options that are often limited and less effective. Previous studies suggest that, in equal‐access health care systems, racial disparities in cancer outcomes are eliminated. However, other research indicates the presence of racial disparities even after accounting for SES factors and access health to enough health care. In fact, one recent study of racial disparities in cancer indicated that even in the same socioeconomic class, blacks die from cancer at higher rate than whites.
In 2019 alone, an estimated 36,840 black men and 36,190 black women are expected to die from cancer, with lung cancer representing the leading cause of cancer death among men and women, followed by breast cancer in women, and prostate cancer in men. Colorectal is the third most prevalent cancer among African Americans.
Despite A Decline, More Needs to be Done
The ACS also reports that cancer death rates were lower in blacks than in whites during the early 1950s, however, that trend changed in the 1960s as rates increased sharply in blacks through the early 1990s, where they peaked in black men and women.
However, recent years have marked steep decline in African American cancer rates. The ACS says that “his progress translates into the avoidance of more than 462,000 deaths from cancer. From 2007 to 2016, the death rate declined faster in blacks than in whites among both males and females. As a result, the overall black‐white racial disparity has narrowed, particularly in males,” adding that “in 1990, the cancer death rate in males was 47% higher in blacks than in whites, but only 19% higher in 2016. Among females, the disparity decreased from 19% in 1990 to 13% in 2016.”
Although cancer rates of African Americans are on a positive trajectory, more needs to be done to narrow the gap. The ACS concluded by saying that “continued progress toward equitable cancer outcomes will require expanding access to high-quality cancer prevention, early detection, and treatment for all Americans.”