Cancer in the Black Community: Cancer Disparities

Cancer is a disease that affects all population groups, but often, Black communities face a larger cancer burden and greater barriers to cancer prevention, diagnosis, treatment and survival. Black people have the highest death rate for cancer overall, and a lower overall 5-year cancer survival rate compared to white people. In 2022, an estimated 224,080 new cancer cases and 73,680 cancer deaths were among Black people in the United States. For Black people, the most commonly diagnosed cancers are prostate, lung, colorectal and breast cancer. These account for more than half of all new cases among Black people. Lung and prostate cancers are the leading causes of cancer deaths for Black men, while breast and lung cancer are the leading causes of cancer deaths for Black women. 

What are some of the factors that contribute to these cancer disparities in the Black community? Research suggests that these cancer disparities are driven by a combination of inequities in health coverage and access to care, social and economic factors, and care and treatment that are rooted in racism and discrimination.

Historical housing policies, like redlining, led to residential segregation where Black people were pushed into segregated urban neighborhoods that often had limited economic resources. These predominantly Black communities are associated with an increased risk of late-stage cancer diagnosis and lower survival rates from breast and lung cancers. Many of these neighborhoods are near industrial facilities that emit harmful toxins into the air, and exposure to these air toxins pose increased cancer risks for its residents. There is also a higher prevalence of food deserts and food swamps and a lower prevalence of safe greenspaces in majority Black communities, which limits the availability of affordable healthy food and opportunities for physical activity. 

Access to care can influence whether someone uses prevention and early detection services and whether they receive cancer treatment and survivorship care. Cost is one of the greatest barriers to high-quality care. Research shows that Black patients are more likely to report health care costs as a significant barrier to cancer follow-up care. Black people are more likely to be uninsured or have inadequate health insurance. Without quality health insurance, they are more likely to skip needed medical care and less likely to receive preventative screenings and services. Being uninsured increases the chance of being diagnosed with advanced cancer and dying from cancer.

Health care discrimination and a mistrust in the medical system also plays a role in racial disparities in cancer. Research has shown that Black people have a higher mistrust in the medical system compared to white people. This is likely due to the history of racial bias and discrimination in our country’s healthcare system. Mistrust in the medical system is associated with lower screening and quality of life in cancer survivors, and it can contribute to the underrepresentation of Black people in clinical trials. Black people are more likely to report negative health experiences during clinical encounters with providers, such as providers believing Black patients are lying or refusing to provide pain medications or other needed treatments. One study found that women who perceived race-based medical discrimination were less likely to be screened for colorectal and breast cancer compared to those not perceiving discrimination.

Underrepresentation of Black people in clinical trials for cancer contributes to disparities in treatment and mortality. There are multiple barriers to not participating in clinical trials for Black patients including a lack of understanding and information about trials, fear and stigma of participating, and time and resource constraints. Also, research suggests that healthcare providers are less likely to discuss clinical trials with Black patients and that clinical trials may exclude a significant portion of Black patients due to coexisting comorbidities or lab cutoffs. Diverse representation in clinical trials is important for determining the effectiveness of cancer therapies for not only the general population but for specific racial/ethnic groups. 

Addressing these contributing factors is an important step to reducing the continued racial disparities in cancer. Reducing the gaps in health insurance and addressing bias and discrimination in health care are key for increasing access to needed medical and cancer care for Black patients. Addressing issues of residential segregation, food deserts/swamps and toxic environmental exposures in Black neighborhoods are important social and economic factors to focus on. Finally, increasing diversity in cancer clinical trials can ensure that advancements in cancer treatment benefit all groups.

We must continue to work together towards health equity in cancer. 

Resources: American Cancer Society, Kaiser Family Foundation, Centers for Disease Control