Despite the extraordinary progress against cancer in the United States—illustrated by the continuing decline in the overall mortality rate, which fell by 33% between 1991 and 2020, and the increasing numbers of cancer survivors (over 18 million and climbing)—the burden of cancer remains disproportionately felt by racial and ethnic minority patients, according to the AACR Cancer Disparities Progress Report 2024, issued by the American Association for Cancer Research (AACR). The report cites the long history of racism, segregation, and discrimination against marginalized populations coupled with a lack of workforce diversity in cancer research and care delivery as contributing factors to health inequities experienced by certain segments of the United States population. The findings in the report emphasize “the vital need for continued transformative research and for increased collaborations to ensure that research-driven advances benefit all people, regardless of their race, ethnicity, age, gender, sexual orientation, socioeconomic status, or geographic location.”
Key Findings on the State of Cancer Disparities
Although there are promising trends in narrowing disparities in some instances—including a significant reduction in the disparity in overall cancer mortality between Black and White individuals over the past 3 decades, from 33% in 1990 to 11.3% in 2020—findings from the 2024 AACR report show that cancer inequities are an ongoing challenge to public health and a major barrier to achieving health equity. For example, compared to White individuals, incidence rates for colorectal and cervical cancers are higher among American Indian and Alaskan Native patients and are also higher for cervical cancer among Hispanic women. Compared to White individuals, the overall cancer death rate is higher among Black and American Indian and Alaskan Native populations. In addition, the report finds that all racial and ethnic minority groups have a lower 5-year relative survival compared to White individuals. Other troubling signs include the alarming rise in early-onset cancers, especially early-onset colorectal cancer in American Indian and Alaskan Native individuals, and the increasing incidence of lung cancer in Asian women who have never smoked.
Some major findings include:
- Although the overall cancer incidence rates among Black and Indigenous populations are lower compared to White populations, Black and Indigenous individuals have the highest overall cancer death rates of all racial and ethnic groups. This disparity is especially noteworthy among Black individuals, as evidenced by:
- Black men are twice as likely to die from prostate cancer compared to White men
- Black women have a 40% higher likelihood of dying from breast cancer, even though the incidence of the disease is similar in both Black and White women
- Black individuals are twice as likely to be diagnosed with and die from multiple myeloma.
- American Indian and Alaskan Native, Asian and Pacific Islander, and Hispanic individuals are more than twice as likely to die from stomach cancer compared to White individuals; these same minority populations also experience higher incidence and mortality rates for liver cancer.
- Zip code and neighborhood of association are contributing factors to cancer disparities. For example, residents of nonmetropolitan or rural counties were 38% more likely to be diagnosed with and die of lung cancer, compared to those living in large metropolitan or urban areas. In addition, non-Hispanic Black women living in low-income neighborhoods were twice as likely to be diagnosed with triple-negative breast cancer as those living in high-income neighborhoods.
- Sexual and gender minorities also face notable health disparities, including:
- Sexual minority women have a higher risk of developing breast cancer compared to heterosexual women.
- Transgender individuals are at a 76% higher risk of being diagnosed with advanced lung cancer compared to cisgender individuals.
- While transgender women appear to be at a 60% lower risk of developing prostate cancer compared to cisgender men, their likelihood of dying from the cancer is nearly double.
Contributing Factors in Health Inequities
Robert A. Winn, MD, FAACR
Margaret Foti, PhD, MD (hc)
“The findings of this report offer a deeper dive into the ‘whole person’ as it relates to the areas outside of medicine that contribute to health inequities: ZNA (zip code and neighborhood association), institutional and systemic racism, and situational and physical barriers to access, to name a few,” said Robert A. Winn, MD, FAACR, Chair of the AACR Cancer Disparities Progress Report 2024 Steering Committee and Director of the Virginia Commonwealth University Massey Comprehensive Cancer Center, in a statement. “As we continue to look at cancer incidences and outcomes and cross-check them against these other factors, while having critical conversations that spur meaningful action within our affiliated communities, our path forward will become clearer. We have seen tremendous progress against cancer in the last few decades, but we must keep fighting to ensure equal access and improved health-care delivery for all people. The key is to keep talking, reporting, and advocating.”
Call to Action
To hasten the elimination of cancer inequities, the AACR Cancer Disparities Progress Report 2024 calls on policymakers and other stakeholders committed to eliminating cancer health disparities to:
- Provide robust, sustained, and predictable funding increases for federal agencies and programs that are tasked with reducing cancer disparities by Congressional appropriation of at least $51.3 billion for the National Institutes of Health and at least $7.9 billion for the National Cancer Institute in fiscal year 2025
- Support data collection initiatives to reduce cancer disparities
- Increase access and participation in clinical trials
- Prioritize cancer control initiatives and increase screening for early detection and prevention:
- Congress should appropriate $472.4 million for the Centers for Disease Control and Prevention’s (CDC’s) Division of Cancer Prevention and Control and provide resources to enable the CDC’s CORE Health Equity Science and Intervention Strategy
- Congress should robustly support the Environmental Protection Agency’s Cancer Moonshot efforts, including the Office of Environmental Justice and External Civil Rights.
- Implement policies to ensure equitable patient care
- Reduce cancer disparities by building a more diverse and inclusive cancer research and care workforce
- Enact comprehensive legislation to eliminate health inequities.
“In this era of extraordinary scientific progress against cancer, it is crucial that we ensure that no populations or communities are left behind,” said Margaret Foti, PhD, MD (hc), Chief Executive Officer of AACR, in a statement. “Health equity is a fundamental human right and must be a national priority. We hope that the information and recommendations in this report will inspire collaboration among stakeholders and the necessary support from Congress to tackle these complex issues and eliminate cancer disparities once and for all.”
