State of Cancer Care

Facing the Facts on Cancer Care

Racial and ethnic minorities suffer from cancer disproportionately for all cancers combined. Black Americans have higher cancer death rates than any other racial group and cancer is the leading cause of death for Hispanic and Asian Americans.

Despite progress in detection, cancers without screenings are more likely to be found in the later stages for individuals who are Black, Hispanic or American Indian/Alaska Native (AI/AN) compared to non-Hispanic White individuals. In recent decades, significant scientific, clinical, and technological advancements have helped drive improvements in cancer outcomes. These disparities in cancer outcomes can have many causes, including environmental, behavioral, social, clinical, and cultural factors.

The American Cancer Society states that the causes of these inequalities are complex and reflect social and economic disparities and cultural differences that affect cancer risk, as well as differences in access to high-quality health care, more than biological differences.

Systematic Issues

Improvements in preventive measures have had a significant impact in bending the cancer mortality curve; however, cancer is still the second leading cause of death in the United States.

Evidence suggests that Black patients are less likely than White patients to receive stage-appropriate treatment or guideline-concordant care across multiple types of invasive cancers.

  • Compared to white patients, Black patients are less likely to receive a lung cancer screening after receiving a referral and are less likely to receive a provider recommendation for surgery for lung cancer. They are also more likely to refuse surgery after it is recommended.
  • Black people also are less likely to be recommended for colorectal screening and are treated less frequently with chemotherapy and radiation for colorectal cancer compared to white patients.
  • For breast and gynecological cancers, Black and Hispanic women are less likely than white women to receive certain evidence-based workup procedures or guideline-recommended treatments. Compared to white women with similar treatment plans, Black women more often have delays in breast cancer treatment initiation. Research has similarly found that compared to white patients, Black and Hispanic patients have increased delays in receipt of surgery for breast cancer. While less studied, work has found that Asian women have a higher rate of receiving no follow-up after abnormal breast cancer screening compared to white women.

Systematic Transformation

Systemic transformation in equitable cancer care requires an acknowledgment of structural racism as a root cause of disparities. A shared vision for equitable, high-quality care integrates patient engagement practices and antiracism strategies with health information technologies to correct these structural inequities and address cancer risk factors related to biology, patient behavior and timely access to care across populations. Systemic transformation requires that individuals and institutions alike accept accountability for our role in the system and commit to driving change through personal actions.

Diversity in Clinical Trials Problems

Clinical trials are research studies carried out by investigators, where participants receive a medical (drug or device), surgical or behavioral intervention. Clinical trials can help test ways to find a disease early before there are symptoms or they can help test out and compare old or new treatments to make sure they are safe and effective.

Participation of racial and ethnic minorities and other underserved populations in clinical trials is critical to accurately determine the efficacy as well as potential toxicities of new treatments in these populations.

Diversity among participants is even more vital during evaluation of cancer types with a disparately higher burden in racial or ethnic minorities, as well as during evaluation of cutting-edge precision medicine, e.g., molecularly targeted therapeutics or immunotherapeutics, because these treatments are closely tied to the unique characteristics of an individual’s cancer, immune system, and lifestyle, among other factors. Enrollment of diverse participants in clinical trials, as well as the race- and ethnicity-specific reporting of the benefits and potential risks, can enable a comprehensive understanding of ancestry-related differences in cancer biology, disease biomarkers, or treatment responses including adverse events and ensure that newly approved anticancer agents can be safely used in the real-world patient population for whom these treatments are ultimately intended.

The Need For Early Detection

When cancer is found earlier, treatment is more likely to be successful. Too often, diagnosis occurs at later stages, after symptoms have developed and the cancer has spread. This is particularly true of unscreened cancers, and especially so among underserved communities, like racial and ethnic minorities and rural populations.Data from the CDC, indicates that cancers with early detection access have higher five year survival rate. Data from the CDC, indicates that cancers with early detection access have higher five year survival rate.

2022 Estimated Cancer Cases

2022 Estimated Cancer Deaths

Death rates, 2015-2019 (Average annual rate per 100,000)

% per year

Currently, unscreened cancers represent roughly 70% of cancer deaths.

For Graph: Average annual rate per 100,000, age-adjusted to the 2000 US standard population

Data sources: National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention, 2021

Systemic transformation in equitable cancer care requires an acknowledgment of structural racism as a root cause of disparities. A shared vision for equitable, high-quality care integrates patient engagement practices and antiracism strategies with health information technologies to correct these structural inequities and address cancer risk factors related to biology, patient behavior and timely access to care across populations. Systemic transformation requires that individuals and institutions alike accept accountability for our role in the system and commit to driving change through personal actions.

CONTACT US

National Minority Quality Forum is a research and educational organization dedicated to ensuring that high-risk racial and ethnic populations and communities receive optimal health care. This nonprofit, nonpartisan organization integrates data and expertise in support of initiatives to eliminate health disparities.

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