Racial disparity is narrowing in cancer mortality

Cancer mortality remains significantly elevated among African Americans. Between 2000 and 2010, overall mortality from cancer decreased faster among African American women and men than among Caucasians. If current trends continue, racial disparities in cancer outcomes are expected to narrow further and might disappear over time. These findings were published in Frontiers in Public Health (2015; doi:10.3389/fpubh.2015.00051).

"Health equity," which is defined by the US Department of Health and Human Services as the highest level of health for all people, has not yet been achieved in America. For example, in 2010 the total mortality rate from cancer was approximately one-fifth higher among African Americans than among Caucasians. The causes of this disparity are complex, but risk factors for cancer that disproportionately affect African Americans include low education and income, and living in less healthy neighborhoods with reduced access to quality health care.

In a new study, Clinical Professor of Health Sciences Eileen O'Keefe and colleagues from Boston University College of Health & Rehabilitation Sciences: Sargent College and Slone Epidemiology Center in Massachusetts, report major changes in cancer mortality in African Americans and Caucasians during the first decade of the 21st century. The researchers analyzed representative nationwide data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute.

O'Keefe and colleagues demonstrate that the disparity between African Americans and Caucasians in total cancer mortality decreased by 14.6% in women (from 16.4% to 14.0%) and 31.1% in men (from 40.2% to 27.7%) during this period. This is due to a faster decrease in cancer mortality among African Americans than among Caucasians. Should these trends continue, racial disparities in cancer outcomes would continue to narrow, and might potentially be eliminated over time.

The progress in cancer outcomes for African Americans seems to be partly driven by increased access to high-quality treatment and surgery, and partly by successful prevention strategies. The latter include helping people to quit smoking; more widespread screening and testing, which allows for earlier diagnosis and raises the probability that treatment will be successful; a decrease in the prescription of hormone replacement therapy (a risk factor for breast cancer) to women in menopause; and an increase in the prescription of anti-inflammatory drugs that lower the risk of colorectal cancers.

Even if these trends are encouraging, O'Keefe and colleagues warn against over-optimism: "Despite significant gains in overall cancer mortality over this time period, persistent cancer disparities by race exist. ... Policy solutions that address access to and quality of the health care system are certainly important toward narrowing disparities, but cannot fully redress broader societal inequities at the core of racial and ethnic health disparities."

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