Breast cancer has surpassed lung cancer as the leading cause of cancer mortality among Black women as of 2019. This news is one of the key findings in Cancer Statistics for African American/Black People 2022, published recently in CA: A Cancer Journal for Clinicians and its consumer-friendly companion, Cancer Facts & Figures for African American/Black People.
African American/Black people have a disproportionately high cancer burden compared with other population groups. According to the report, the risk of cancer death for Black individuals remains 19% higher for men and 12% higher for women compared with White individuals. The gap for breast cancer is more alarming; Black women are 41% more likely to die of breast cancer than White women despite a lower risk of being diagnosed with the disease.
Higher cancer mortality rates are partly due to later stage diagnosis. For example, just 57% of breast cancer cases in Black women are detected at a localized stage compared with 67% in White women, contributing to the lower overall 5-year survival rate—82% in Black women vs 92% in White women. However, Black women have lower breast cancer survival for every stage of diagnosis, including a 10-percentage point gap for distant-stage disease (20% vs 30% in White women).
Disparities and Structural Racism
Reasons for these disparities are complex but largely stem from less access to high-quality care and optimal treatment as a repercussion of long-standing institutional racism.
Karen Knudsen, MD
“African Americans continue to have a disproportionate burden of cancer mortality largely because of lack of health insurance and other socioeconomic barriers that limit access to cancer prevention and care,” said Karen Knudsen, MD, American Cancer Society (ACS) Chief Executive Officer. “Moreover, African American people are overrepresented in states that have not expanded Medicaid. Expanding access to care for all low-income persons and increasing trust in the medical community through provider education can substantially reduce the burden of cancer in African Americans.”
To monitor progress in reducing these inequalities, investigators at the ACS compile the most recent data on cancer incidence, mortality, survival, screening, and risk factors for Black people in the United States every 3 years using population-based data from the National Cancer Institute and the Centers for Disease Control and Prevention.
Cancer Incidence Lower but Cancer Mortality Greater in Black People
Lung cancer continues to be the leading cause of cancer mortality in Black men but was eclipsed by breast cancer in 2019 in Black women. This is largely because of a recent acceleration in the decline in lung cancer mortality for Black and White men and women. Although the decline in the lung cancer mortality is welcome news, lung cancer remains the second most commonly diagnosed cancer in both Black men and women.
Prostate cancer is the most commonly diagnosed cancer in Black men. Incidence rates are 73% higher than in White men, and prostate cancer mortality rates are more than twice as high in Black men (37.9 vs 17.8 per 100,000 from 2015–2019). The larger disparity for prostate cancer mortality likely in part reflects lower quality treatment in Black men, which has even been demonstrated within equal-access health systems such as the Veterans Health Administration. Thus, it is particularly worrisome, the researchers noted, that the diagnosis of advanced-stage prostate cancer has been increasing in Black and White men by at least 5% per year since 2012 as a result of the decrease in prostate-specific antigen testing.
“Cancer disparities in the Black community are the result of myriad causes rooted in institutional inequities,” said Tawana Thomas-Johnson, Senior Vice President and Chief Diversity Officer at the ACS. “We must address structural racism as a public health issue to close the gaps and advance health equity.”
The report concludes that continued documentation of inequalities in the health of Black people is necessary but insufficient to effect change. Future research should not only explore the influence of systemic racism on health but also develop mechanisms to reverse the course, from requirements for increased diversity in clinical trials and provider education to health system financial incentives for the provision of equitable care across the cancer continuum.
The report noted other key statistics regarding disparities in cancer incidence and cancer mortality rates in Black vs White people. In 2022, there will be an estimated 224,080 new cancer cases and 73,680 cancer deaths among Black people. Over the past 5 data years, Black women have 8% lower overall cancer incidence than White women but 12% higher mortality; Black men have 6% higher cancer incidence than White men and 19% higher cancer mortality.
Despite an increase in the diagnosis of distant-stage prostate cancer in Black men of 5% annually since 2012, prostate cancer mortality continued to decline from 2015 through 2019 by 1.3% per year, albeit slower than the 5% per year decline from 2010 through 2014.
The overall cancer mortality gap between Black and White people is narrowing because of a steeper drop among Black people in prostate, lung, and other smoking-related cancers.
Compared with White men and women, colorectal cancer incidence rates are 21% higher in Black men and 18% higher in Black women, whereas mortality rates are 44% higher in Black men and 31% higher in Black women.
To view the full report, visit www.cancer.org.