Cancer death rates have steadily declined among Black Americans over the past 2 decades, but they still remain higher than mortality rates in other racial and ethnic groups. Those were the key findings of a recent study published online ahead of print in JAMA Oncology that examined national trends in cancer death rates from 1999 to 2019 using the data obtained from the National Center for Health Statistics, which includes all cancer deaths in the United States for people age 20 or older during that time (2022; doi: 10.1001/jamaoncol.2022.1472).
"The steady decline in overall cancer death rates among Black individuals likely reflects advances in cancer prevention, detection, and treatment, as well as population changes in exposure to cancer risk factors in the U.S.," stated the study's lead author, Wayne Lawrence, DrPH, MPH, a postdoctoral fellow in the Metabolic Epidemiology Branch of the Division of Cancer Epidemiology and Cancer Prevention at the National Cancer Institute. "However, despite the decrease in cancer mortality rates, Black individuals continue to have the highest rate compared to other racial and ethnic groups, highlighting the need to address the pervasiveness of this longstanding racial inequity."
The dataset analyzed for the research included 1,361,663 cancer deaths among Black Americans, and it looked at cancer mortality rates by cancer type. The data showed the following findings:
* From 1999 to 2019, cancer deaths declined by approximately 2 percent among Black Americans per year and more so for Black men than Black women (cancer deaths declined by 2.6% per year for Black men and 1.5% per year for Black women).
* Death rates declined for most cancer types; the most rapid decreases were for lung cancer among men (3.8% decrease in death pers year) and stomach cancer among women (3.4% decrease in deaths per year).
* During this time period, liver cancer deaths increased for Black men and women ages 65-79.
* Also during this time, uterine cancer deaths increased among Black women ages 35-79.
* When cancer death rates were compared among racial and ethnic groups, Black men and women had higher rates of cancer death (both overall and for most cancer types) than White, Asian and Pacific Islander, American Indian and Alaska Native, and Hispanic and Latino men and women.
Decreased Smoking & Lower Rates
This study provides some important insights about cancer death rates in the United States, particularly when it comes to lung cancer, noted Farhad Islami, MD, PhD, Senior Scientific Director of Cancer Disparity Research at the American Cancer Society. Overall lung cancer deaths nationally are declining, likely due to lower rates of smoking, and recent evidence shows this declining trend has been accelerating in the last decade, likely due to the introduction of new medicines and improvements in clinical management of lung cancer, he said. "The current study has found a similar trend among Black individuals: an acceleration in declines in lung cancer death rates among both Black men and women since 2013."
Another significant finding is that liver cancer mortality trends are consistent among Black individuals with others in the United States; they are increasing in some older age groups, but remaining stable or declining in young age groups, Islami added.
And according to Lawrence, the finding that uterine cancer mortality is increasing among older Black women was noteworthy. But he added that the finding was consistent with other data recently published in JAMA Oncology, and that those researchers also noted that the trend called for more investigation of possible mechanisms (2022; doi: 10.1001/jamaoncol.2022.0009).
Health Disparities Still Exist
Lawrence noted that it was good news to see declines in overall cancer death rates for Black Americans for most cancer, but disappointing to see how much higher cancer mortality rates are for Black people than for other racial and ethnic groups.
"It was troubling to see that death rates from cancers with well-established means of early detection and improved long-term survival (such as breast and prostate cancers) were markedly higher among Black individuals compared to others," he said.
There's a need for more research to understand how social inequities contribute to higher cancer mortality among Black Americans, he added. That research should examine things like why Black individuals are more likely to reside in neighborhoods with poor access to cancer specialists, see a physician with less access to clinical resources, and live in communities with greater exposure to environmental hazards linked to cancer risk, he noted.
Disparities in cancer mortality have largely been attributed to differences in exposure to risk factors, early detection, and access to preventive care and treatment, which themselves are influenced by conditions in which individuals are born, grow, work, live, and age, as well as forces and systems that shape the conditions of daily life-the social determinants of health, Ismali said.
"These conditions could impact cancer mortality through their effects on educational and job opportunities, income, housing, transportation, public safety, food security, social inclusion and nondiscrimination, and access to affordable health services of high quality," he noted.
Health insurance coverage is another major factor that often defines someone's access and receipt of health care services in the United States, with people with limited or lower incomes more likely to be uninsured or underinsured, Ismali added.
Karen Winkfield, MD, PhD, Professor of Radiation Oncology at Vanderbilt University Medical Center and Executive Director of the Meharry-Vanderbilt Alliance, noted that she was not surprised by the report's findings.
"More focus needs to be placed on social determinants of health and reducing barriers to cancer care along the continuum, from prevention through treatment and end-of-life care. There are several great examples of interventions that work," she said, citing an article she wrote on the topic last year (J Oncol Pract 2021; doi: 10.1200/OP.20.00630). "We know what to do; in fact, we've known for decades. We just need to have the will as a nation to do what is needed and change how health care is delivered."
And in the meantime, Lawrence said that practicing oncologists and cancer care providers should discuss with marginalized patients any potential barriers those patients may encounter in the course of their cancer care.
"Clinicians must be aware that many of the causes for racial disparities in cancer death rates are primarily systemic and preventable (for example, cancer being diagnosed at more advanced stages in Black Americans). Also, Black patients are more likely to experience poor patient-physician interaction, longer referrals, delay in treatment, less frequent physician follow-up, greater medical mistrust, underuse of treatment, and health care system failure (when the patient and physician agree on treatment, but that treatment does not happen for unknown reasons), which are all mutable factors," Lawrence concluded.
Sarah DiGiulio is a contributing writer.