New Study Calls for Action to Reverse Course of Racial Disparities

The differences in the cancer burden between Black people and White people occur largely because of the decades that society and the US government have fostered discrimination via structural racism.

Structural racism is caused by the proliferation and continuation of mutually reinforcing, unfair systems in housing, education, employment, earnings, credit, health care and insurance, and criminal justice.

The practice of redlining—prejudiced housing policies that denied mortgage loans to credit-worthy applicants—prevented the accumulation of generational wealth and perpetuated a “racial wealth gap that persists today,” the study authors say.

According to the US Census Bureau data, in 2023:

• 18% of Black people live below the federal poverty level, compared to 8% of White people.
• 8% of Black people are underinsured for health care, compared to 5% of White people.

For most cancers, an increase in socioeconomic status decreases the risk of mortality. However, at every economic level, Black people have a higher cancer mortality than White people.

Areas where redlining used to occur are still areas associated with increased health risks—including cancer diagnoses at later stages when they are harder to treat and higher rates of death from cancer. These health risks persist even if the neighborhood's economic status has risen.

One study, for example, showed that older women with breast cancer living in historically redlined areas were more likely to receive substandard treatment for and die from breast cancer compared with women in other neighborhoods.

People with a lower socioeconomic status are more likely to experience risk factors for cancer including smoking and obesity, as well as barriers to high-quality cancer screening and care.

Tackling these issues, say the study authors, includes “strengthening our health care system through policies that eliminate cost-sharing copays” and “innovative strategies and financial incentives to promote equitable care delivery across the cancer continuum.” 

Steep declines in smoking initiation in Black teens 40 to 50 years ago, especially for boys, contributed to the improvements in cancer death rates for Black people that we see today, particularly the large declines in middle-aged men.

Smoking causes approximately 30% of cancer deaths. The graph below shows that smoking has declined for both Black and White males and females over the last 30 years. But the gap still exists, as Black men continued to have the highest prevalence of smoking over the last 50 years.

Smoking prevalence may be higher in Black men for several reasons: One is that smoking rates are higher among populations with limited incomes because of targeted advertising by tobacco companies.

Today, tobacco companies continue to use targeted marketing in poor neighborhoods—offering discounts and promotions to entice people to start, or keep, smoking.

In 2020, smoking rates were 20% for adults with an annual household income of less than $35,000, compared with overall adult smoking rate of 12.5%.

Smoking causes at least 12 different cancers, including 86% of lung cancers, the leading cause of cancer death for both Black men and women.

A consistently higher prevalence of obesity in Black females increases their risk of cancer incidence and mortality for obesity-related cancers.

Black women have a 57% prevalence of obesity, compared to 40% for White women.

As with smoking, a high prevalence of obesity is more likely in people with a low socioeconomic status. Low-income neighborhoods are less likely to have access to fresh and healthy food and areas for safe outdoor physical activity. Those barriers contribute to an increased risk of developing obesity-related types of cancer.

Obesity is associated with an increased risk of many cancers and may contribute to higher incidence and mortality rates in Black women than in White women for cancers of the stomach, pancreas, liver, kidney, colorectum, and uterine corpus (endometrial cancer), as well as myeloma.

Excess body weight is the only known modifiable risk factor for myeloma. Myeloma incidence is about 20% higher in adults who have overweight or obesity.

Black males now have much lower death rates than they did decades ago, but there’s more to the story. 

As described above, the decline in cancer death rates for Black males is largely due to reductions in the prevalence of smoking. Still, the death rate for specific cancers—like prostate cancer, the most common cancer in men—is much higher for Black males compared to White males.

Prostate cancer. Black men have the highest prostate cancer death rate of any racial or ethnic group in the US during 2018 to 2022—more than 2 times higher than White men.

A primary reason is suboptimal treatment—even when care is provided through an equal-access health system. A 2021 Veterans Health Administration study found that Black men were 11% less likely than other men to receive definitive treatment for prostate cancer.

Colorectal cancer. Black men and women have the second highest incidence of colorectal cancer in the US, after American Indian and Alaska Native people.

Compared with White men, incidence rates for colorectal cancer were 20% higher in Black men from 2017 to 2021. Death rates from colorectal cancer are 40% higher in Black men compared with white men.

One reason for both these disparities is because smoking is more common in Black men. Smoking also makes healing after treatment more difficult.

Other factors that increase the risk of developing colorectal cancer include: 

• Being physically inactive
• Drinking alcohol heavily 
• Having an unhealthy diet that's high in red and/or processed meat and low in calcium
• Having obesity

The 5-year survival rate for colorectal cancer is 59% in Black people compared to 65% in White people. Numerous studies have shown that Black people with colorectal cancer are less likely than White people to receive recommended surgical treatment, radiation, and chemotherapy. Plus, Black people are more likely to have treatment delays than White people, even when the racial groups have similar socioeconomic backgrounds.

Lung cancer. Lung is the second most common cancer in both Black men and women and is the leading cause of cancer death among Black men and Women combined.

As discussed above, both incidence and death rates have declined more in Black men compared with White men due to the sharper reduction in tobacco use.

Although early diagnosis improves lung cancer survival dramatically, only 17% of eligible Black people (ages 20 to 79) and 14% of eligible White people are being screened with low-dose computed tomography based on the guidelines.

The lower cancer incidence rate in Black women compared to White women is likely due to barriers to cancer screening or getting a diagnosis, not because fewer Black women develop cancer.

Compared to White women, Black women have a 10% higher rate of cancer death despite a 9% lower incidence rate.

Breast cancer. Black women have a 38% higher risk of dying from breast cancer, compared to White women, even though Black women have a 5% lower likelihood of being diagnosed with breast cancer. The causes for this disparity include:

• Diagnosis at a later stage when the cancer is typically harder to treat. (Only 58% of Black women were diagnosed when cancer was localized to the breast, compared with 68% of White Women.)
• Less access to timely, high-quality treatment compared with White women.
• Barriers that block the completion of treatment.
• A higher prevalence of obesity compared with White women.
• Higher prevalence of more aggressive subtypes compared with White women. (Black women are twice as likely to be diagnosed with types of breast cancer that have the worst prognosis: triple-negative breast cancer and inflammatory breast cancer.)

Lung cancer. Black and White women had similar lung cancer mortality until the early 1990s. Then, from 2018 to 2022, Black women had a 16% lower death rate than White women. This is largely because of the consistently lower smoking rates for Black women.

Colorectal cancer. Compared with White women, incidence rates for colorectal cancer were 14% higher in Black women. One reason for this disparity is that having obesity increases the risk of developing colorectal cancer, and Black women have a high rate of obesity. Death rates for colorectal cancer are 25% higher in Black women compared to White women.

Uterine corpus (endometrial cancer). The incidence rate for endometrial cancer is about the same for Black and White women—about 28 cases per every 100,000 women. Recent increases are linked with increases in body weight. Black women are twice as likely to die from endometrial cancer compared to White women.

The Black-White disparity in 5-year survival rates is among the largest for endometrial cancer, with Black women having 63% survival compared with 84% in White women. Some of the reasons for this difference are:

• Almost half of endometrial cancers diagnosed in Black women are not found until they’re at an advanced stage, when they’re harder to treat, compared with 30% of late-stage diagnoses in White women.
• Black women are more likely to be diagnosed with an aggressive type of endometrial tumor compared with White women.
• Black women are less likely to receive timely treatment that is recommended by guidelines compared to White women.

Cervical cancer. In the 1960s and 1970s, women started getting screened for cervical cancer, and that led to decreases in incidence and death rates for Black and White women. From 2012 to 2021, cervical cancer incidence continued to decline in Black women by about 1% a year while incidence stabilized in White women.

One reason for the decline is the high rate of HPV vaccination for Black adolescents: 69% of Black girls were up-to-date with recommended vaccinations and 62% of Black boys were, compared with 63% of White girls and 57% of White boys.

Still, Black women have a 53% higher risk of dying from cervical cancer compared to White females.